Clinical score and arterial oxygen saturation in children with wheezing associated respiratory illness (WARI).
OBJECTIVE
To determine the correlation between clinical score (based on respiratory rate, chest wall retractions, air entry, wheezing, consciousness and audible wheezing) and arterial oxygen saturation (SaO2: measured by pulse oximetry) as well as the most appropriate total score for predicting hypoxemia (SaO2 < or = 95%) in children diagnosed to have wheezing associated respiratory illness (WARI).


METHODS
70 children (1 month-5 years old) hospitalized in the Department of Pediatrics, Chulalongkorn Hospital with the diagnosis of WARI from January 1, 1996 to December 31, 1996 were studied. Half of them were diagnosed to have acute lower respiratory tract infection (LRI) with wheezing while the remainder had reactive airway disease (RAD).


METHODS
Cross sectional, analytical study.


METHODS
In each group of patients, the clinical score and SaO2 were assessed by the same pediatrician throughout the study. The correlation between the clinical signs and SaO2 as well as the cut off point of total score for predicting hypoxemia were analyzed. The sensitivity, specificity and accuracy of that total score in predicting hypoxemia were also calculated.


RESULTS
In both groups of patients (acute LRI with wheezing and RAD group), the clinical signs correlated with SaO2 were wheezing (rs = -0.67 and -0.47 respectively) and chest wall retractions (rs = -0.57 and -0.59 respectively). Total score was also correlated with SaO2 (rs = -0.68 and -0.5 respectively). The cut off point of total score in predicting hypoxemia was 4 providing 80 per cent sensitivity in both groups with accuracy 74.3 per cent and 80 per cent respectively.


CONCLUSIONS
This clinical score may be used to assess the severity of hypoxemia in WARI patients. Wheezing, chest wall retractions and total score correlated well with SaO2. The total score > 4 was most appropriate in predicting hypoxemia in both children with RAD and wheezing associated with LRI.
Sritippayawan
S
S
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Deerojanawong
J
J
Prapphal
N
N
D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000175:diagnosis*; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012143:Respiratory Physiological Phenomena; D012135:Respiratory Sounds / Q000175:diagnosis*; D012140:Respiratory Tract Diseases / Q000150:complications / Q000175:diagnosis*; D012720:Severity of Illness Index
D010100:Oxygen