Can clinical symptoms or signs accurately predict hypoxemia in children with acute lower respiratory tract infections?
OBJECTIVE
To determine clinical predictors of hypoxemia in children with acute lower respiratory tract infection (ALRI).


METHODS
Cross-sectional study.


METHODS
Emergency department of All India Institute of Medical Sciences, a tertiary care hospital.


METHODS
109 under five children, with ALRI.


METHODS
Clinical symptoms and signs were recorded. Oxygen saturation was determined by a pulse oximeter. Hypoxemia was defined as oxygen saturation less than 90%. The ability of various clinical symptoms and signs to predict the presence of hypoxemia was evaluated.


RESULTS
Twenty-eight (25.7%) children were hypoxemic. No symptoms were statistically associated with hypoxemia. Tachypnea, suprasternal indrawing, intercostal indrawing, lower chest indrawing, cyanosis, crepitations, and rhonchi were statistically significantly associated with hypoxemia. A simple model using the presence of rapid breathing (> or =80/min in children < or =3 m, > or =70/min in >3-12 m and > or =60/min in >12 m) or lower chest indrawing had a sensitivity of 78.5% and specificity of 66.7% for detecting hypoxemia. No individual clinical symptom/sign or a combination had both sufficient sensitivity and specificity to identify hypoxemia.


CONCLUSIONS
None of the clinical features either alone or in combination have desirable sensitivity and specificity to predict hypoxemia in children with acute lower respiratory tract infection.
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.
Rakesh
R
Lodha
Prateek Singh
PS
Bhadauria
Anoop Verghese
AV
Kuttikat
Madhavi
M
Puranik
Saurabh
S
Gupta
R M
RM
Pandey
S K
SK
Kabra
D000208:Acute Disease; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D007223:Infant; D008297:Male; D016017:Odds Ratio; D010092:Oximetry; D011237:Predictive Value of Tests; D011659:Pulmonary Gas Exchange; D012129:Respiratory Function Tests; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000453:epidemiology; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index