Low tissue oxygen saturation at emergency center triage is predictive of intensive care unit admission

Purpose: Timely recognition of critical patients by emergency center triage is an ongoing challenge. Peripheral tissue oxygen saturation (Sto(2)) measurement has been used to monitor shock patients' responses to resuscitation. Interest has developed in evaluating Sto(2) as a triage tool, but limited studies have addressed critically ill patients. Material and methods: This is a single-center, retrospective study of 158 emergent cancer patients with hypotension and/or modified systemic inflammatory response syndrome who underwent Sto(2) spot measurement at triage. Results: Of the 57 patients with Sto(2) less than 70%, 17 went to the intensive care unit (ICU), whereas only 14 of the 101 patients with Sto(2) of 70% to 89% (P = .01) went to the ICU. There was no significant difference in non-ICU hospital admission or mortality between the 2 groups. The odds ratio of ICU admission for patients with Sto(2) less than 70% relative to those with Sto(2) of 70% to 89% was 2.64 (95% confidence interval, 1.18-5.87) and 2.87 (95% confidence interval, 1.23-6.66) when adjusted for mean arterial pressure, pulse, and temperature. Conclusions: In this patient population, an Sto(2) less than 70% significantly increased the risk of ICU admission. Tissue oxygen saturation at triage identifies critical patients who may not be recognized by vital signs alone. Tissue oxygen saturation measurement could help providers make earlier decisions regarding hospital resource allocation. (C) 2014 Elsevier Inc. All rights reserved.