Pulse Oximeter Accuracy in Children and Outpatient Implementation

Acute lower respiratory infections (ALRI) are the leading cause of death in children under 5 years of age worldwide. They account for a large proportion of pediatric emergency visits across diverse care settings. Hypoxemia is both a risk factor for mortality and a driver of disease progression. Building on prior successes, this proposal aims to advance the use of pulse oximetry in children. Our work found that an SpO₂ (peripheral oxygen saturation) of 90–92% was associated with child ALRI mortality, consistent with retrospective studies showing that SpO₂ may overestimate arterial oxygen saturation (SaO₂). Stakeholders often prioritize interventions that are perceived as low-cost and high-output; however, the true cost of pulse oximetry implementation in outpatient settings remains unknown. For outpatient pulse oximeters to reduce child ALRI mortality and morbidity, they must accurately and reliably measure SpO₂ while also being financially and time-cost effective. The aims of this mixed-methods study are to 1) examine the accuracy of SpO₂ in critically ill children and 2) compare the costs of ambulatory reflectance versus transmissive pulse oximetry implementation for outpatient ALRI care. These aims align with the NHLBI mission to lead the world in advancing translational research that bridges clinical research to practice and connects population-level data to health outcomes. Interventions that improve early identification of hypoxemic children and provision of appropriate care are critical to reducing ALRI mortality. This proposal leverages the underexplored role of cost analysis, compares objective measures with clinician perceptions of time-costs in pulse oximetry use, and generates essential data to inform future studies aimed at refining SpO₂ interpretation to improve child outcomes. Dr. Hooli is a pediatric emergency medicine physician with a career focus on patient-oriented research. The educational plan includes formal, tutorial, and practical experiences in prospective study design and analysis, cost analysis, and implementation science. She is mentored by scientists with expertise in these fields and child respiratory infections, pediatric emergency care, and pulse oximetry. Execution of these aims coupled with the educational and mentorship plan outlined in the proposal will prepare Dr. Hooli to become an independent investigator.