Abstract
Background
In developing countries, facilities for measuring arterial oxygen saturation are not available in most settings, which make it difficult for health providers to detect hypoxemia in children with acute respiratory tract infection (ARI). Most health providers rely on symptoms and signs to identify hypoxemia and start oxygen therapy. Therefore, this study was conducted to determine the clinical predictors of hypoxemia in children with ARI.
Methods
It was a cross-sectional study carried out at the Pediatric Emergency Department of GSVM Medical College, Kanpur, India in children in the age group between 2 months and 5 years, presenting with ARI. All children with ARI attending the pediatric emergency department from April 2007 to September 2008 were included in the study. Clinical signs and symptoms including fever, cough, nasal flaring, inability to feed/drink, cyanosis, chest wall retraction, wheezing, grunting, tachypnea and crepitations were noted and oxygen saturation (SpO2) was measured. Hypoxemia was defined as SpO2 <90%.
Results
Of the 261 children included in the study, 62 (23.8%) had hypoxemia. Chest wall retraction (sensitivity=90%), crepitations (sensitivity=87%), nasal flaring (sensitivity=84%), tachypnea (sensitivity=81%) and inability to feed (sensitivity=81%) were observed to be the most sensitive indicators of hypoxemia while the best predictors were cyanosis [positive predictive value (PPV)=88%] and nasal flaring (PPV=53%).
Conclusions
Chest wall retraction was found to be the most sensitive indicator, and cyanosis was the most specific indicator for hypoxemia. Of all the clinical signs and symptoms of hypoxemia, none had all the attributes of being a good predictor. A new hypoxemia score has been designed using a combination of clinical signs and symptoms to predict the need for supplemental oxygen therapy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
World Health Organization, 2001. http://www.who.int/vaccine_research/diseases/ari/en/ (accessed January 14, 2012).
Chretein J, Holland W, Macklem P, Murray J, Woolock A. Acute Respiratory infection in children: a global public health problem. N Engl J Med 1984;310:982–984.
Duke T, Frank D, Mgone J. Hypoxemia in children with severe pneumonia in Papua New Guinea. Int J Tuberc Lung Dis 2000;5:511–519.
Onyango FE, Steinhoff MC, Wafula EM, Wariua S, Musia J, Kitonyi J. Hypoxemia in young Kenyan children with acute lower respiratory, infection. BMJ 1993;306:612–615.
World Health Organization, 1991. http://whqlibdoc.who.int/hq/1991/WHO_ARI_91.20.pdf (accessed January 14, 2012).
Duke T, Blaschke AJ, Sialis S, Bonkowsky JL. Hypoxemia in acute respiratory and non respiratory illnesses in neonates and children in a developing country. Arch Dis Child 2002;86:108–112.
Singhi S, Deep A, Kaur H. Prevalence and predictors of hypoxemia in acute respiratory infections presenting to pediatric emergency department. Indian J Crit Care Med 2003;7:118–123.
RTI Facts: IAP Consensus guidelines on Rational Management of Respiratory Tract Infections in children. IAP Action Plan 2006. Published by Indian Academy of Pediatrics (IAP).
Shann F, Hart K, Thomas D. Acute lower respiratory tract infections in children: possible criteria for selection of patients for antibiotic therapy and hospital admission. Bull World Health Organ 1984;62:749–753.
Mwaniki MK, Nokes DJ, Ignas J, Munywoki P, Ngama M, Newton C, et al. Emergency triage assessment for hypoxemia in neonates and young children in a Kenyan hospital: an observational study. Bull World Health Organ 2009;87:263–270.
Lodha R, Bhadauria PS, Kuttikat AV, Puranik M, Gupta S, Pandey RM, et al. Can clinical symptoms or signs accurately predict hypoxemia in children with acute lower respiratory tract infections? Indian Pediatr 2004;41:129–135.
Subhi R, Adamson M, Campbell H, Weber M, Smith K, Duke T, et al. The prevalence of hypoxemia among ill children in developing countries: a systematic review. Lancet Infect Dis 2009;9:219–227.
Usen S, Weber M, Mulholland K, Jaffar S, Oparaugo A, Omosigho C, et al. Clinical predictors of hypoxemia in Gambian children with acute lower respiratory tract infection: prospective cohort study. BMJ 1999;318:86–91.
Key Indicators for Uttar Pradesh from National Family Health Survey (NFHS) — 3. http://www.nfhsindia.org/pdf/Uttar%20Pradesh.pdf (accessed January 14, 2012).
Lozano JM. Epidemiology of hypoxemia in children with acute lower respiratory infection. Int J Tuberc Lung Dis 2001;5:496–504.
Dyke T, Brown N. Hypoxia in childhood pneumonia: better detection and more oxygen needed in developing countries. BMJ 1994;308:119–120.
Wang EL, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev Respir Dis 1992;145:106–109.
Ayieko P, English M. In children aged 2–59 months with pneumonia, which clinical signs best predict hypoxaemia? J Trop Pediatr 2006;52:307–310.
Stadie WC. The treatment of anoxemia in pneumonia in an oxygen chamber. J Exp Med 1922;35:337–360.
Barach AL. Methods and results of oxygen treatment in pneumonia. Arch Intern Med 1926;37:186–211.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rao, Y.K., Midha, T., Kumar, P. et al. Clinical predictors of hypoxemia in Indian children with acute respiratory tract infection presenting to pediatric emergency department. World J Pediatr 8, 247–251 (2012). https://doi.org/10.1007/s12519-012-0365-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12519-012-0365-1