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Oxygen saturation: a crucial "vital sign" being neglected

Letters

CJEM 2002;4(4):244

To the Editor:

Since the 1980s the ability to estimate the saturation of oxygen in peripheral blood (Sao2) relatively accurately and non-invasively has become a standard in assessment of a patients ability to supply oxygen to the tissues.1 Sao2 essentially represents the ability to assess the end product of the pulse, blood pressure and respiratory function, and has been found to be more reliable than respiratory rate in screening for hypoxia.2 With its ease of procurement, the Sao2 might be considered the newest and, arguably, most important, "vital" sign.3,4

In an audit of the clinical records of 867 patients discharged with an ED diagnosis of "pneumonia" (714) or "possible pneumonia" (153), over a 2-year period (Jan. 3, 1999 - Jan. 3, 2001), we found that the Sao2 of the patient was not recorded anywhere on the clinical record in 17.9% (155) of cases, despite a policy for it to be recorded at triage, and during the nursing assessment, with a space on the assessment form dedicated to the Sao2 measurement at each stage. By contrast, the other "vital signs" were recorded in over 99% of cases.

It is disturbing that a patient could be discharged with a diagnosis of a potentially seriously respiratory illness without this basic and potentially critical measurement being recorded. We wonder if other centres have identified this as a problem.

Sam Campbell
Ward Patrick
Dalhousie University
Halifax, NS

References

  1. Middleton PM, Henry JA. Pulse oximetry: evolution and directions. Int J Clin Pract 2000;54:438-44.
  2. Mower WR, Sachs C, Nicklin EL, Safa P, Baraff LJ. A comparison of pulse oximetry and respiratory rate in patient screening. Respir Med 1996;90:593-9.
  3. Summers RL, Anders RM, Woodward LH, Jenkins AK, Galli RL. Effect of routine pulse oximetry measurements on ED triage classification. Am J Emerg Med 1998;16:5-7.
  4. Mower WR, Sachs C, Nicklin EL, Safa P, Baraff LJ. Effect of routine emergency department triage pulse oximetry screening on medical management. Chest 1995;108:1297-302.
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