Oxygen Saturation

References

• Ebell MH, Chupp H, Cai X, Bentivegna M, Kearney M. Accuracy of Signs and Symptoms for the Diagnosis of Community-acquired Pneumonia: A Meta-analysis. Acad Emerg Med. 2020;27(7):541-553. PMID: 32329557.
• Modern GOLD guideline reference (open access): Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2024 Report). Available at https://goldcopd.org. (GOLD defines an exacerbation as 'an acute worsening of respiratory symptoms that results in additional therapy' per the 2017 Rome Proposal definition; SpO2 is part of severity assessment, not diagnostic criteria.) Anthonisen criteria primary reference: Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987;106(2):196-204. doi:10.7326/0003-4819-106-2-196. PMID: 3492164. (Symptom-based exacerbation definition: dyspnea + sputum volume + sputum purulence.) Oxygen-therapy guideline reference (BTS): O'Driscoll BR, Howard LS, Davison AG, et al. BTS guideline for emergency oxygen use in adult patients. Thorax. 2017;72(Suppl 1):ii1-ii90. (Target SpO2 88-92% for COPD patients at risk of hypercapnic respiratory failure; supports the baseline-relative framing.)
• PERC rule primary reference (includes SpO2 <95% as 1 of 8 components): Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247-55. PMID: 15304025. PERC validation: Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-80. PMID: 18318689. PERC SR/MA: Singh B, Mommer SK, Erwin PJ, Mascarenhas SS, Parsaik AK. Pulmonary embolism rule-out criteria (PERC) in pulmonary embolism — revisited: a systematic review and meta-analysis. Emerg Med J. 2013;30(9):701-6. PMID: 23038695. (Pools PERC composite not per-component.) PE decision-rule references (no SpO2 component): Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism. Thromb Haemost. 2000;83(3):416-20. PMID: 10744147. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144(3):165-71. PMID: 16461960.
• Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944-1956. doi:10.1001/jama.294.15.1944. PMID: 16234501. (JAMA Rational Clinical Examination original article. Full PDF behind JAMA Network paywall; abstract examined this session.) Modern HF guideline reference: Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145(18):e895-e1032. PMID: 35363499. Modern critical-care use of SpO2 in acute HF: Nieminen MS, Bohm M, Cowie MR, et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure. Eur Heart J. 2005;26(4):384-416. PMID: 15681577. (Discusses SpO2 in acute-HF severity assessment.)
• Modern guideline references: Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention (2024 Report). Available at https://ginasthma.org. (GINA uses SpO2 <90% as life-threatening criterion alongside silent chest, cyanosis, confusion, exhaustion, hypotension, arrhythmia, fatigue.) National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma. NIH Publication 07-4051; 2007. Updated 2020 Focused Updates: Cloutier MM, Baptist AP, Blake KV, et al. 2020 Focused Updates to the Asthma Management Guidelines. J Allergy Clin Immunol. 2020;146(6):1217-1270. doi:10.1016/j.jaci.2020.10.003. PMID: 33280709.
• Keahey L, Bulloch B, Becker AB, Pollack CV Jr, Clark S, Camargo CA Jr; Multicenter Asthma Research Collaboration (MARC) Investigators. Initial oxygen saturation as a predictor of admission in children presenting to the emergency department with acute asthma. Ann Emerg Med. 2002 Sep;40(3):300-307. doi:10.1067/mem.2002.126813. PMID: 12192354.
• ATLS reference: American College of Surgeons Committee on Trauma. Advanced Trauma Life Support: Student Course Manual. 10th ed. American College of Surgeons; 2018. (Tension pneumothorax as clinical diagnosis requiring immediate decompression.) Roberts DJ, Leigh-Smith S, Faris PD, et al. Clinical presentation of patients with tension pneumothorax: a systematic review. Ann Surg. 2015;261(6):1068-78. doi:10.1097/SLA.0000000000001073. PMID: 25563887. (Comprehensive SR of clinical presentation but not pooled DTA for individual vital-sign features.) Eastern Association for the Surgery of Trauma practice management guideline: Inaba K, Branco BC, Eckstein M, et al. Optimal positioning for emergent needle thoracostomy. J Trauma. 2011;71(5):1099-103. PMID: 22071914.
• Sepsis-3 primary references: Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287. PMID: 26903338. PMC: PMC4968574. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis. JAMA. 2016;315(8):762-774. PMID: 26903335. Surviving Sepsis Campaign 2021 guidelines: Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49(11):e1063-e1143. doi:10.1097/CCM.0000000000005337. PMID: 34605781. SOFA primary reference: Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707-10. PMID: 8844239.
• Phua SL, Hawke FE, Chuter VH, Tehan PE. Sensitivity and Specificity of Pulse Oximetry for Identification of Peripheral Artery Disease: A Systematic Review. J Cardiovasc Nurs. 2025;40(2):E65-E71 (published online 2023). doi:10.1097/JCN.0000000000001030. PMID 37787731. PROSPERO CRD42021265049.
• McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.