Quique Bassat1,2, Miguel Lanaspa1,2, Sónia Machevo2, Cristina O'Callaghan-Gordo1,2,3, Lola Madrid1,2, Tacilta Nhampossa2,4, Sozinho Acácio2,4, Anna Roca2,5, Pedro L Alonso1,2. 1. ISGlobal, Barcelona Centre of International Health Research, Universitat de Barcelona, Barcelona, Spain. 2. Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique. 3. Centre for Research in Environmental Epidemiology, Barcelona, Spain. 4. National Institute of Health, Ministry of Health, Maputo, Mozambique. 5. Medical Research Council Unit, Banjul, The Gambia.
Abstract
OBJECTIVE: To determine the prevalence of hypoxaemia among under-five children admitted to hospital with clinical severe pneumonia and to assess the performance to diagnose hypoxaemia of models based on clinical signs. METHODS: We conducted a hospital-based survey in a district hospital from Southern Mozambique. RESULTS: A total of 825 children were recruited after obtaining an informed consent. The prevalence of hypoxaemia on admission was 27.9%, and 19.8% of these children died (OR compared with non-hypoxaemic children 3.22, 95% CI 1.98-5.21, P < 0.001). The model with larger area under the ROC curve (AUC-ROC) to predict hypoxaemia included cyanosis or thoracoabdominal breathing or respiratory rate ≥70 breaths per minute. None of the models performed well when tested in different case scenarios of oxygen availability through mathematical modelling, with over 50% of hypoxaemic children not receiving oxygen even in favourable case scenarios. CONCLUSIONS: Clinical signs alone or in combination are not suitable to diagnose hypoxaemia. The use of pulse oximeters should be strongly encouraged.
OBJECTIVE: To determine the prevalence of hypoxaemia among under-five children admitted to hospital with clinical severe pneumonia and to assess the performance to diagnose hypoxaemia of models based on clinical signs. METHODS: We conducted a hospital-based survey in a district hospital from Southern Mozambique. RESULTS: A total of 825 children were recruited after obtaining an informed consent. The prevalence of hypoxaemia on admission was 27.9%, and 19.8% of these children died (OR compared with non-hypoxaemic children 3.22, 95% CI 1.98-5.21, P < 0.001). The model with larger area under the ROC curve (AUC-ROC) to predict hypoxaemia included cyanosis or thoracoabdominal breathing or respiratory rate ≥70 breaths per minute. None of the models performed well when tested in different case scenarios of oxygen availability through mathematical modelling, with over 50% of hypoxaemic children not receiving oxygen even in favourable case scenarios. CONCLUSIONS: Clinical signs alone or in combination are not suitable to diagnose hypoxaemia. The use of pulse oximeters should be strongly encouraged.
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Authors: Hamish Graham; Ayobami A Bakare; Adejumoke I Ayede; Oladapo B Oyewole; Amy Gray; David Peel; Barbara McPake; Eleanor Neal; Shamim A Qazi; Rasa Izadnegahdar; Trevor Duke; Adegoke G Falade Journal: EClinicalMedicine Date: 2019-10-24
Authors: Hamish R Graham; Ayobami A Bakare; Adejumoke I Ayede; Amy Z Gray; Barbara McPake; David Peel; Olatayo Olatinwo; Oladapo B Oyewole; Eleanor F G Neal; Cattram D Nguyen; Shamim A Qazi; Rasa Izadnegahdar; John B Carlin; Adegoke G Falade; Trevor Duke Journal: PLoS Med Date: 2019-11-11 Impact factor: 11.069