To the Editor.

In response to the call of Mower et al to add pulse oximetry to the standard panel of vital signs (“Pulse Oximetry as a Fifth Pediatric Vital Sign,” Pediatrics. 1997;99:681–686), I must object.

The authors have presented data that convincingly demonstrate that the use of pulse oximetry changed the frequency with which a variety of tests and interventions took place. With oximetry, more chest x-rays were obtained, more blood gas determinations drawn, and more children admitted. Diagnoses were changed or added in a number of cases.

Although clinical practice was altered by adding pulse oximetry to the routine of evaluation, the most important question was begged: did the intervention of pulse oximetry benefit the children? The authors point out that moderate hypoxia may not induce tachypnea, so that oximetry would appear superior to respiratory rate in detecting hypoxia. I do not doubt this point. But have the...

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