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June 2016

Bronchiolitis and Pulse OximetryChoosing Wisely With a Technological Pandora’s Box

Author Affiliations
  • 1Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora
  • 2Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 3University of Pennsylvania, Philadelphia

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Pediatr. 2016;170(6):531-532. doi:10.1001/jamapediatrics.2016.0090

In this issue of JAMA Pediatrics, Principi et al1 report the findings of their study titled, “Effect of Desaturations on Subsequent Medical Visits in Infants Discharged From the Emergency Department With Bronchiolitis.” The investigators prospectively enrolled infants with bronchiolitis deemed suitable for discharge and monitored them with continuous pulse oximetry at home for the first day. The essential element of this study is that the pulse oximeter had deactivated threshold alarms and did not display saturation values. The monitors, in addition to study diaries, were collected and analyzed, and the patients received follow-up calls at 72 hours. The results of this study call into question the assumptions of current practice around use of pulse oximetry for decision making in bronchiolitis, but they likely are not surprising to experienced clinicians. Principi and colleagues found desaturations to be a common event after discharge from the emergency department, with two-thirds of the infants having at least 1 desaturation episode at home and many having sustained desaturations to 70% or less. The primary outcome of rate of unscheduled visits was the same in both groups, at approximately 25%, which included unscheduled visits to the primary care physician and the emergency department. There was also no difference in hospitalizations between those who had desaturation episodes and those who did not. The study places the issue of transient desaturations and their clinical importance at the forefront of the discussion around management of these patients. In addition, it adds to the dilemma of which patients should receive pulse oximetry in their evaluation and how to interpret the values.

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