Comparison of pulse oximetry and earlobe blood gas with CO-oximetry in children with sickle cell disease: a retrospective review.

ABSTRACT:

Objectives

To investigate the agreement between pulse oximetry (SpO₂) and oxygen saturation (SaO₂) measured by CO-oximetry on arterialised earlobe blood gas (EBG) in children and adolescents with sickle cell disease (SCD).

Design and setting

We retrospectively reviewed 39 simultaneous and paired SaO₂ EBG and SpO₂ measurements from 33 ambulatory patients with SCD (32 subjects with Haemoglobin SS and one with Haemoglobin Sß⁺, 52% male, mean±SD?age 11.0±3.6, age range 5-18). Measurements were performed between 2012 and 2015 when participants were asymptomatic. Hypoxaemia was defined as SaO₂ ?93%. A Bland-Altman analysis was performed to assess the accuracy of SpO₂ as compared with EBG SaO₂.

Results

The mean±SD SpO₂ and SaO₂ values in the same patients were, respectively, 93.6%±3.7% and 94.3%±2.9%. The bias SpO₂-SaO₂ was -0.7% (95% limits of agreement from -5.4% to 4.1%) and precision was 2.5%. In 9/39 (23%) cases, the difference in SpO₂-SaO₂ was greater than the expected error range ±2%, with SaO₂ more often underestimated by SpO₂ (6/9), especially at SpO₂values ?93%. Thirteen participants (33%) were hypoxaemic. The sensitivity of SpO₂ for hypoxaemia was 100%, specificity 85% and positive predictive value 76%.

Conclusions

Pulse oximetry was inaccurate in almost a quarter of measurements in ambulatory paediatric patients with SCD, especially at SpO₂values ?93%. In these cases, oxygen saturation can be confirmed through EBG CO-oximetry, which is easier to perform and less painful than traditional arterial blood sampling.

SUBMITTER: Arigliani M 

PROVIDER: S-EPMC7299039 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature