title: Development and Internal Validation of a Predictive Model Including Pulse Oximetry for Hospitalization of Under-Five Children in Bangladesh.
abstract: BACKGROUND
  The reduction in the deaths of millions of children who die from infectious diseases requires early initiation of treatment and improved access to care available in health facilities. A major challenge is the lack of objective evidence to guide front line health workers in the community to recognize critical illness in children earlier in their course.
  
  
  METHODS
  We undertook a prospective observational study of children less than 5 years of age presenting at the outpatient or emergency department of a rural tertiary care hospital between October 2012 and April 2013. Study physicians collected clinical signs and symptoms from the facility records, and with a mobile application performed recordings of oxygen saturation, heart rate and respiratory rate. Facility physicians decided the need for hospital admission without knowledge of the oxygen saturation. Multiple logistic predictive models were tested.
  
  
  RESULTS
  Twenty-five percent of the 3374 assessed children, with a median (interquartile range) age of 1.02 (0.42-2.24), were admitted to hospital. We were unable to contact 20% of subjects after their visit. A logistic regression model using continuous oxygen saturation, respiratory rate, temperature and age combined with dichotomous signs of chest indrawing, lethargy, irritability and symptoms of cough, diarrhea and fast or difficult breathing predicted admission to hospital with an area under the receiver operating characteristic curve of 0.89 (95% confidence interval -CI: 0.87 to 0.90). At a risk threshold of 25% for admission, the sensitivity was 77% (95% CI: 74% to 80%), specificity was 87% (95% CI: 86% to 88%), positive predictive value was 70% (95% CI: 67% to 73%) and negative predictive value was 91% (95% CI: 90% to 92%).
  
  
  CONCLUSIONS
  A model using oxygen saturation, respiratory rate and temperature in combination with readily obtained clinical signs and symptoms predicted the need for hospitalization of critically ill children. External validation of this model in a community setting will be required before adoption into clinical practice.
authors.affiliation: Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Shahreen
authors.initials: S
authors.lastname: Raihana
authors.affiliation: Centre for International Child Health, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.|The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Dustin
authors.initials: D
authors.lastname: Dunsmuir
authors.affiliation: Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Tanvir
authors.initials: T
authors.lastname: Huda
authors.affiliation: The Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Guohai
authors.initials: G
authors.lastname: Zhou
authors.affiliation: Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Qazi Sadeq-Ur
authors.initials: QS
authors.lastname: Rahman
authors.affiliation: The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Ainara
authors.initials: A
authors.lastname: Garde
authors.affiliation: Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Md
authors.initials: M
authors.lastname: Moinuddin
authors.affiliation: The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Walter
authors.initials: W
authors.lastname: Karlen
authors.affiliation: Centre for International Child Health, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.|The Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Guy A
authors.initials: GA
authors.lastname: Dumont
authors.affiliation: Centre for International Child Health, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.|The Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Kissoon
authors.affiliation: Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.affiliation: Centre for International Child Health, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.|The Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Charles
authors.initials: C
authors.lastname: Larson
authors.affiliation: Centre for International Child Health, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.|The Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: J Mark
authors.initials: JM
authors.lastname: Ansermino
mesh_terms: D019540:Area Under Curve; D001459:Bangladesh; D015415:Biomarkers / Q000032:analysis; D002675:Child, Preschool; D003141:Communicable Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D016638:Critical Illness / Q000628:therapy*; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D005260:Female; D006339:Heart Rate; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010092:Oximetry; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D056152:Respiratory Rate; D062606:Tertiary Care Centers
chemical_list: D015415:Biomarkers