Predictors of hypoxaemia in hospital admissions with acute lower respiratory tract infection in a developing country
a Medical Research Council
Laboratories, Fajara, The Gambia, b Royal Victoria
Hospital, Banjul, The Gambia
Correspondence to: Dr Martin Weber, Medical Research Council Laboratories, PO Box 273, Fajara, Banjul, The Gambia, West Africa.
Accepted 5 November 1996
Since oxygen has to be given to most children in developing
countries on the basis of clinical signs without performing blood gas
analyses, possible clinical predictors of hypoxaemia were studied.
Sixty nine children between the ages of 2 months and 5 years admitted
to hospital with acute lower respiratory tract infection and an oxygen
saturation (SaO2) < 90% were compared with
67 children matched for age and diagnosis from the same referral hospital with an SaO2 of 90% or above (control
group 1), and 44 unreferred children admitted to a secondary care
hospital with acute lower respiratory infection (control group 2).
Using multiple logistic regression analysis, sleepiness, arousal,
quality of cry, cyanosis, head nodding, decreased air entry, nasal
flaring, and upper arm circumference were found to be independent
predictors of hypoxaemia on comparison of the cases with control group
1. Using a simple model of cyanosis or head nodding or not crying, the
sensitivity to predict hypoxaemia was 59%, and the specificity 94%
and 93% compared to control groups 1 and 2, respectively; 80% of the
children with an SaO2 < 80% were identified
by the combination of these signs. Over half of the children with
hypoxaemia could be identified with a combination of three signs:
extreme respiratory distress, cyanosis, and severely compromised
general status. Further prospective validation of this model with other datasets is warranted. No other signs improved the sensitivity without
compromising specificity. If a higher sensitivity is required, pulse
oximetry has to be used.
© 1997 by Archives of Disease in Childhood
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