0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Bronchiolitis and Pulse Oximetry Choosing Wisely With a Technological Pandora’s Box

Lalit Bajaj, MD, MPH1; Joseph J. Zorc, MD, MSCE2,3
[+] 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
JAMA Pediatr. 2016;170(6):531-532. doi:10.1001/jamapediatrics.2016.0090.
Text Size: A A A
Published online

Extract

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.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,016 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();