Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort study.
OBJECTIVE
To determine clinical correlates and outcome of hypoxaemia in children admitted to hospital with an acute lower respiratory tract infection.


METHODS
Prospective cohort study.


METHODS
Paediatric wards of the Royal Victoria Hospital and the hospital of the Medical Research Council's hospital in Banjul, the Gambia.


METHODS
1072 of 42 848 children, aged 2 to 33 months, who were enrolled in a randomised trial of a Haemophilus influenzae type b vaccine in the western region of the Gambia, and who were admitted with an acute lower respiratory tract infection to two of three hospitals.


METHODS
Prevalence of hypoxaemia, defined as an arterial oxygen saturation <90% recorded by pulse oximetry, and the relation between hypoxaemia and aetiological agents.


RESULTS
1072 children aged 2-33 months were enrolled. Sixty three (5.9%) had an arterial oxygen saturation <90%. A logistic regression model showed that cyanosis, a rapid respiratory rate, grunting, head nodding, an absence of a history of fever, and no spontaneous movement during examination were the best independent predictors of hypoxaemia. The presence of an inability to cry, head nodding, or a respiratory rate >/= 90 breaths/min formed the best predictors of hypoxaemia (sensitivity 70%, specificity 79%). Hypoxaemic children were five times more likely to die than non-hypoxaemic children. The presence of malaria parasitaemia had no effect on the prevalence of hypoxaemia or on its association with respiratory rate.


CONCLUSIONS
In children with an acute lower respiratory tract infection, simple physical signs that require minimal expertise to recognise can be used to determine oxygen therapy and to aid in screening for referral. The association between hypoxaemia and death highlights the need for early recognition of the condition and the potential benefit of treatment.
Usen
S
S
Medical Research Council Laboratories, PO Box 273, Fajara, Gambia. susen@mrc.enda.sn
Weber
M
M
Mulholland
K
K
Jaffar
S
S
Oparaugo
A
A
Omosigho
C
C
Adegbola
R
R
Greenwood
B
B
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000150:complications / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005714:Gambia / Q000453:epidemiology; D018073:Haemophilus Vaccines; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008288:Malaria / Q000150:complications; D008297:Male; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000150:complications* / Q000517:prevention & control; D012680:Sensitivity and Specificity
D018073:Haemophilus Vaccines