Initial ED oxygen saturation ≤90% increases the risk of a complicated hospital course in pediatric asthmatics requiring admission


      Emergency physicians are responsible for admitting children with asthma who do not respond to initial therapy. We examined the hypothesis that an initial room air pulse oximetry ≤90% elevates the risk of a complicated hospital course in children who require admission with acute asthma.


      Charts of all patients ages 2 years–17 years admitted for asthma from January 2017 to December 2017 were reviewed. An explicit chart review was performed by trained data extractors using a standardized form. Results: A total of 244 children meeting inclusion criteria were admitted for asthma from the ED during the study period. All patients had an initial room air pulse oximetry documented. Sixty-five were admitted to PICU status (27%), and 179 (73%) were admitted to floor status. The relative risk of a complicated course in those patients presenting with a saturation of ≤90% was 11.3 (95% CI 3.9–32.6). The mean initial pulse oximetry on patients with a complicated course was 85% versus 93% for those without a complicated course (p < 0.005).


      Our data suggest that in pediatric asthmatics that require admission from the ED, those with pulse oximetry readings less than or equal to 90% on presentation are at higher risk of a complicated hospital course.


      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. National Asthma Education Program, Expert Panel Report 3; National Heart, Blood and Lung Institute; Guidelines for the Diagnosis and Management, 2007: pp-373-405.

        • Wood D.W.
        • Downes J.J.
        • Lecks H.I.
        A clinical scoring system for the diagnosis of respiratory failure. Preliminary report on childhood status asthmaticus.
        Am J Dis Child. 1972; 123: 227-228
        • Becker A.B.
        • Nelson N.A.
        • Simons E.R.
        The Pulmonary Index: assessment of a clinical score for asthma.
        Am J Dis Child. 1984; 138: 574-576
        • Chalut D.S.
        • Ducharme F.M.
        • Davis G.M.
        The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity.
        J. Pediatr. 2000; 137: 762-768
        • Gorelick M.H.
        • Stevens M.W.
        • Schultz T.R.
        • et al.
        Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma.
        Acad. Emerg. Med. 2004; 11: 10-18
        • Arnold D.H.
        The RAD score: a simple acute asthma severity score compares favorably to more complex scores.
        Ann. Allergy Asthma Immunol. 2011; 107 (July): 22-28
        • Kerem E.
        • Canny G.
        • Tibshirani R.
        • Reisman J.
        • Bentur L.
        • et al.
        Clinical-physiologic correlation in acute asthma of childhood.
        Pediatrics. 1991; 87: 481-486
        • Geelhoed G.C.
        • Landau L.I.
        • LeSouef P.N.
        Evaluation of SaO2 as a predictor of outcome in 280 children presenting with acute asthma.
        Ann. Emerg. Med. 1994; 23: 1236-1241
        • Bishop J.
        • Nolan T.
        Pulse oximetry in acute asthma.
        Arch. Dis. Child. 1991; 66: 724-725
        • Pollack C.V.
        • Pollack E.S.
        • Baren J.M.
        • et al.
        A prospective multicenter study of patient factors associated with hospital admission from the emergency department among children with acute asthma.
        Arch. Pediatr. Adolesc. Med. 2002; 156: 934Y940
        • Wright R.O.
        • Santucci K.A.
        • Jay G.D.
        • Steele D.W.
        Evaluation of pre- and posttreatment pulse oximetry in acute childhood asthma.
        Acad. Emerg. Med. 1997; 4: 114-117
        • Keahy L.
        • Bulloch B.
        • Becker A.B.
        • Pollack Jr., C.V.
        • Clark S.
        • et al.
        Initial oxygen saturation as a predictor of admission in children presenting to the emergency department with acute asthma.
        Ann. Emerg. Med. 2002 Sep; 40: 300-307
        • Gorelick M.H.
        • Scribano P.
        Predicting need for hospitalization in acute pediatric asthma.
        Pediatr. Emerg. Care. 2008; 24: 735-744
        • Mayefsky J.H.
        • El-Shinaway Y.
        The usefulness of pulse oximetry in evaluating acutely ill asthmatics.
        Pediatr. Emerg. Care. 1992; 8: 262-264

      CHORUS Manuscript

      View Open Manuscript