In Infants with Bronchiolitis, Study Points to Need for Re-evaluation of Clinical Care, Diagnostic Tools

In Infants with Bronchiolitis, Study Points to Need for Re-evaluation of Clinical Care, Diagnostic Tools

In a new study, researchers at The Hospital for Sick Children (SickKids) in Toronto, Canada, analyzed the suitability of pulse oximetry as a decision-making tool in bronchiolitis, and concluded that a re-evaluation is required.

The research article, “Effect of Oxygen Desaturations on Subsequent Medical Visits in Infants Discharged From the Emergency Department With Bronchiolitis,” and the accompanying editorial, “Bronchiolitis and Pulse Oximetry: Choosing Wisely With a Technological Pandora’s Box,” were both published in the journal JAMA Pediatrics.

Clinical evidence has shown that reliance on pulse oximetry, a test used to measure the oxygen level (oxygen saturation) in the blood, has been associated with higher incidence of hospitalizations and prolonged hospital stays. In this study, researchers aimed to measure the difference in the proportion of unscheduled medical visits after emergency department visits in infants with bronchiolitis who have oxygen desaturations during home oximetry monitoring compared to infants without oxygen desaturations.

The study enrolled 118 patients between 6 weeks and 12 months old, discharged from the emergency department with a diagnosis of acute bronchiolitis. Besides the main objective of the study, secondary outcomes included examination of the severity and duration of the desaturations, and delayed hospitalizations within 72 hours of discharge.

The results showed that, following the mean monitoring period of 19 hours and 57 minutes, 75 of the 118 infants (64 percent) had at least one desaturation event, and 59 of the patients (50 percent) had at least three desaturations. Twelve patients (10 percent) had a desaturation event lasting longer than 10 percent of the monitored time, and 51 patients (43 percent) had a desaturation lasting three minutes or longer. Of the 75 infants who had desaturations, 18 (24 percent) had an unscheduled visit for bronchiolitis, while 11 of the 43 patients (26 percent) without desaturation had a visit.

The research team concluded that, in the cohort of infant patients enrolled in the study, desaturations were a common event after discharge from the emergency department, and that the number of hospitalizations and unscheduled return medical visits was similar between those who had desaturation episodes and those who did not. The results raised the question about the appropriate care and pulse oximetry value in the management of the babies.

In the editorial article, researchers noted, “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.”

The authors suggested that the study results question the current practice of using pulse oximetry in the decision-making process in infants with bronchiolitis, and that its relevance should be re-evaluated.

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