Initial oxygen saturation values can predict the need to hospitalise children with mild wheezing.
OBJECTIVE
Mild wheezing during respiratory infections is a common cause of paediatric hospital admissions. This study aimed to identify factors predicting this condition in children over six months of age.


METHODS
We reviewed the medical records of 539 children, aged 6 months to 16 years, who visited the emergency department because of wheezing during respiratory infection. Mild disease was defined as hospital stays of less than 48 h and severe disease was staying at least 48 h or being treated in intensive care. Patients with an initial oxygen saturation value (SaO2 ) below 90% were analysed separately.


RESULTS
Most (87%) of the 539 patients had mild disease, 6% had a severe disease and 7% had an initial SaO2 below 90%. The area under the receiver operating characteristic (ROC) curve for the initial SaO2 predicting mild disease was 0.75 (95% CI 0.53-0.97), and the optimal cut-off value was 93%. An initial SaO2 >93% had a negative predictive value of 93%. Although 270 patients (50%) were hospitalised, only 140 (26%) would have been admitted using an optimal cut-off of SaO2 ≤93%.


CONCLUSIONS
An initial SaO2 >93% reflects a mild course of acute wheezing and using this cut-off point could have almost halved hospital admissions.
Department of Paediatrics, University of Oulu, University Hospital of Oulu, Oulu, Finland.
H
H
Pruikkonen
M
M
Uhari
T
T
Dunder
T
T
Pokka
M
M
Renko
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D010100:Oxygen / Q000378:metabolism*; D011237:Predictive Value of Tests; D012135:Respiratory Sounds / Q000175:diagnosis* / Q000209:etiology; D012141:Respiratory Tract Infections / Q000150:complications / Q000378:metabolism / Q000628:therapy; D012720:Severity of Illness Index
D010100:Oxygen
Hospitalisation; Initial oxygen saturation; Respiratory infection; Wheezing