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. 1997 Apr;76(4):310–314. doi: 10.1136/adc.76.4.310

Predictors of hypoxaemia in hospital admissions with acute lower respiratory tract infection in a developing country

M Weber 1, S Usen 1, A Palmer 1, S Jaffar 1, E Mulholland 1
PMCID: PMC1717166  PMID: 9166021

Abstract

Accepted 5 November 1996


Since oxygen has to be given to most children in developing countries on the basis of clinical signs without performing blood gas analyses, possible clinical predictors of hypoxaemia were studied. Sixty nine children between the ages of 2 months and 5 years admitted to hospital with acute lower respiratory tract infection and an oxygen saturation (SaO2) < 90% were compared with 67 children matched for age and diagnosis from the same referral hospital with an SaO2 of 90% or above (control group 1), and 44unreferred children admitted to a secondary care hospital with acute lower respiratory infection (control group 2). Using multiple logistic regression analysis, sleepiness, arousal, quality of cry, cyanosis, head nodding, decreased air entry, nasal flaring, and upper arm circumference were found to be independent predictors of hypoxaemia on comparison of the cases with control group 1.Using a simple model of cyanosis or head nodding or not crying, the sensitivity to predict hypoxaemia was 59%, and the specificity 94% and 93% compared to control groups 1 and 2, respectively; 80% of the children with an SaO2 < 80% were identified by the combination of these signs. Over half of the children with hypoxaemia could be identified with a combination of three signs: extreme respiratory distress, cyanosis, and severely compromised general status. Further prospective validation of this model with other datasets is warranted. No other signs improved the sensitivity without compromising specificity. If a higher sensitivity is required, pulse oximetry has to be used.



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Selected References

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  1. Dyke T., Lewis D., Heegaard W., Manary M., Flew S., Rudeen K. Predicting hypoxia in children with acute lower respiratory infection: a study in the highlands of Papua New Guinea. J Trop Pediatr. 1995 Aug;41(4):196–201. doi: 10.1093/tropej/41.4.196. [DOI] [PubMed] [Google Scholar]
  2. Garenne M., Ronsmans C., Campbell H. The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries. World Health Stat Q. 1992;45(2-3):180–191. [PubMed] [Google Scholar]
  3. Lozano J. M., Steinhoff M., Ruiz J. G., Mesa M. L., Martinez N., Dussan B. Clinical predictors of acute radiological pneumonia and hypoxaemia at high altitude. Arch Dis Child. 1994 Oct;71(4):323–327. doi: 10.1136/adc.71.4.323. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. MORRISON B. Anoxia in the acute respiratory infections of childhood; its recognition and treatment. Lancet. 1955 Oct 8;269(6893):737–740. doi: 10.1016/s0140-6736(55)92436-3. [DOI] [PubMed] [Google Scholar]
  5. Margolis P. A., Ferkol T. W., Marsocci S., Super D. M., Keyes L. L., McNutt R., Harrell F. E., Jr Accuracy of the clinical examination in detecting hypoxemia in infants with respiratory illness. J Pediatr. 1994 Apr;124(4):552–560. doi: 10.1016/s0022-3476(05)83133-6. [DOI] [PubMed] [Google Scholar]
  6. Mulholland E. K., Olinsky A., Shann F. A. Clinical findings and severity of acute bronchiolitis. Lancet. 1990 May 26;335(8700):1259–1261. doi: 10.1016/0140-6736(90)91314-z. [DOI] [PubMed] [Google Scholar]
  7. Onyango F. E., Steinhoff M. C., Wafula E. M., Wariua S., Musia J., Kitonyi J. Hypoxaemia in young Kenyan children with acute lower respiratory infection. BMJ. 1993 Mar 6;306(6878):612–615. doi: 10.1136/bmj.306.6878.612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Reuland D. S., Steinhoff M. C., Gilman R. H., Bara M., Olivares E. G., Jabra A., Finkelstein D. Prevalence and prediction of hypoxemia in children with respiratory infections in the Peruvian Andes. J Pediatr. 1991 Dec;119(6):900–906. doi: 10.1016/s0022-3476(05)83040-9. [DOI] [PubMed] [Google Scholar]
  9. Shann F., Barker J., Poore P. Clinical signs that predict death in children with severe pneumonia. Pediatr Infect Dis J. 1989 Dec;8(12):852–855. doi: 10.1097/00006454-198912000-00005. [DOI] [PubMed] [Google Scholar]
  10. Simpson H., Flenley D. C. Arterial blood-gas tensions and pH in acute lower-respiratory-tract infections in infancy and childhood. Lancet. 1967 Jan 7;1(7480):7–12. doi: 10.1016/s0140-6736(67)92419-1. [DOI] [PubMed] [Google Scholar]
  11. Spooner V., Barker J., Tulloch S., Lehmann D., Marshall T. F., Kajoi M., Alpers M. P. Clinical signs and risk factors associated with pneumonia in children admitted to Goroka Hospital, Papua New Guinea. J Trop Pediatr. 1989 Dec;35(6):295–300. doi: 10.1093/tropej/35.6.295. [DOI] [PubMed] [Google Scholar]

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