Effect of Oximetry on Hospitalization in Bronchiolitis A Randomized Clinical Trial
Effect of Oximetry on Hospitalization in Bronchiolitis A Randomized Clinical Trial
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DOI：
10.1001/jama.2014.8637
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发表时间：
2014-08-20
影响因子：
120.7
通讯作者：
Willan, Andrew R.
中科院分区：
文献类型：
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作者：
Schuh, Suzanne;Freedman, Stephen;Willan, Andrew R.
重要性 脉搏血氧饱和度的常规使用与细支气管炎管理的变化有关，并可能降低了细支气管炎患者的住院阈值。 目的 检查显示的血氧饱和度测量值被人为提高高于真实值 3 个百分点的细支气管炎婴儿，与显示真实值的婴儿相比，其住院率是否至少降低 15%。 设计、设置和参与者 随机、双盲、 2008 年至 2013 年在加拿大安大略省多伦多市的三级儿科急诊科进行的平行组试验。参与者是 213 名 4 周至 12 个月大的健康婴儿，患有轻度至中度细支气管炎，真实氧饱和度为 88% 或更高。 干预措施 脉搏血氧饱和度测量显示真实饱和度值或显示改变的饱和度值，该值比真实值增加了 3 个百分点。 主要结果和措施 主要结果是 72 小时内住院，定义为在此间隔内住院或积极住院治疗超过 6 小时。次要结局包括急诊科补充氧气的使用情况、医生对急诊科出院的同意程度、急诊科住院时间以及 72 小时内因细支气管炎而计划外就诊。 结果 真实血氧测定组 108 名患者中的 44 名患者 (41%) 和改变血氧测定组 105 名患者中的 26 名患者 (25%) 在 72 小时内住院（差异为 16% [95%]） Cl 为差异，3.6% 至 28.4%]；P = .005）。使用急诊科医生作为随机效应，主要治疗效果仍然显着（调整后的比值比，4.0 [95% CI，1.6 至 10.5]；P = .009）。各组之间的次要结果均无显着差异。在真实血氧测定组中，108 名患者中，有 23 名 (21.3%) 因细支气管炎而进行了计划外就诊，而在改变血氧测定组中，105 名患者中，有 15 名 (14.3%) 因细支气管炎而进行了后续计划外就诊（差异为 7% [95% CI，-0.3% 至 0.2%]；P = .18）。 结论和相关性对于中度细支气管炎，与血氧饱和度读数未改变的患者相比，脉搏血氧饱和度读数人为升高的患者在 72 小时内住院或接受积极住院治疗超过 6 小时的可能性较小。这表明氧饱和度不应成为决定入院的唯一因素，其使用可能需要重新评估。
IMPORTANCE Routine use of pulse oximetry has been associated with changes in bronchiolitis management and may have lowered the hospitalization threshold for patients with bronchiolitis.OBJECTIVE To examine if infants with bronchiolitis whose displayed oximetry measurements have been artificially elevated 3 percentage points above true values experience hospitalization rates at least 15% lower compared with infants with true values displayed.DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, parallel-group trial conducted from 2008 to 2013 in a tertiary-care pediatric emergency department in Toronto, Ontario, Canada. Participants were 213 otherwise healthy infants aged 4 weeks to 12 months with mild to moderate bronchiolitis and true oxygen saturations of 88% or higher.INTERVENTIONS Pulse oximetry measurements with true saturation values displayed or with altered saturation values displayed that have been increased 3 percentage points above true values.MAIN OUTCOMES AND MEASURES The primary outcome was hospitalization within 72 hours, defined as inpatient admission within this interval or active hospital care for greater than 6 hours. Secondary outcomes included the use of supplemental oxygen in the emergency department, level of physician agreement with discharge from the emergency department, length of emergency department stay, and unscheduled visits for bronchiolitis within 72 hours.RESULTS Forty-four of 108 patients (41%) in the true oximetry group and 26 of 105 (25%) in the altered oximetry group were hospitalized within 72 hours (difference, 16% [95% Cl for the difference, 3.6% to 28.4%]; P = .005). Using the emergency department physician as a random effect, the primary treatment effect remained significant (adjusted odds ratio, 4.0 [95% CI, 1.6 to 10.5]; P = .009). None of the secondary outcomes were significantly different between the groups. There were 23 of 108 (21.3%) subsequent unscheduled medical visits for bronchiolitis in the true oximetry group and 15 of 105 (14.3%) in the altered oximetry group (difference, 7% [95% CI,-0.3% to 0.2%]; P = .18).CONCLUSIONS AND RELEVANCE Among infants presenting to an emergency department with mild to moderate bronchiolitis, those with an artificially elevated pulse oximetry reading were less likely to be hospitalized within 72 hours or to receive active hospital care for more than 6 hours than those with unaltered oximetry readings. This suggests that oxygen saturation should not be the only factor in the decision to admit, and its use may need to be reevaluated.