Varun Alwadhi1, Pooja Dewan, Rajeev Kumar Malhotra, Dheeraj Shah, Piyush Gupta. 1. Departments of Pediatrics, and *Biostatistics and Medical Informatics, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India. Correspondence to: Dr Piyush Gupta, Professor of Pediatrics, Department of Pediatrics, University College of Medical Sciences, Delhi 110 095, India. prof.piyush.gupta@gmail.com.
Abstract
OBJECTIVE: To compare the performance of respiratory rate and other clinical signs against pulse oximetry for predicting hypoxia in children with Severe pneumonia/Very severe disease as per Integrated Management of Neonatal and Childhood Illness (IMNCI) classification. DESIGN: Cross-sectional study. SETTING: Pediatric emergency department of a tertiary-care hospital in Delhi, India. SUBJECTS: 112 hospitalized children (2 mo - 5 y) with Severe pneumonia/Very severe disease as per IMNCI classification. METHODS: Respiratory rate was recorded at enrolment, along with other clinical signs and symptoms. Oxygen saturation (SpO2) was measured by a pulse oximeter. Clinical predictors of hypoxia (SpO2 <90%) and their combinations (index test) were evaluated for their sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of hypoxia, against pulse oximetry (reference test). RESULTS: Hypoxia was present in 57 (50.9%) children. Presence of tachypnea, head nodding, irritability, inability to drink/breastfeed, vomiting, and altered sensorium was significantly associated with hypoxia (P<0.05). Multiple logistic regression revealed that age-specific tachypnea (RR≥70/min for 2-12 mo, and RR ≥60/min for ≥12 mo), head nodding, and inability to drink/breastfeed were independent predictors for hypoxia with sensitivity of 70.2%, 50.9% and 75.4%, respectively; and specificity of 88.9%, 96.4%, and 90.9%, respectively. When all three predictors were used in conjunction, the sensitivity increased to 91.2% and specificity was 81.8%. CONCLUSION: No single clinical sign can perform as well as pulse oximetry for predicting hypoxia in children with severe pneumonia. In settings where pulse oximetry is not available, combination of signs, age-specific tachypnea, head nodding, and inability to drink/breastfeeding has acceptable sensitivity and specificity.
OBJECTIVE: To compare the performance of respiratory rate and other clinical signs against pulse oximetry for predicting hypoxia in children with Severe pneumonia/Very severe disease as per Integrated Management of Neonatal and Childhood Illness (IMNCI) classification. DESIGN: Cross-sectional study. SETTING: Pediatric emergency department of a tertiary-care hospital in Delhi, India. SUBJECTS: 112 hospitalized children (2 mo - 5 y) with Severe pneumonia/Very severe disease as per IMNCI classification. METHODS: Respiratory rate was recorded at enrolment, along with other clinical signs and symptoms. Oxygen saturation (SpO2) was measured by a pulse oximeter. Clinical predictors of hypoxia (SpO2 <90%) and their combinations (index test) were evaluated for their sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of hypoxia, against pulse oximetry (reference test). RESULTS:Hypoxia was present in 57 (50.9%) children. Presence of tachypnea, head nodding, irritability, inability to drink/breastfeed, vomiting, and altered sensorium was significantly associated with hypoxia (P<0.05). Multiple logistic regression revealed that age-specific tachypnea (RR≥70/min for 2-12 mo, and RR ≥60/min for ≥12 mo), head nodding, and inability to drink/breastfeed were independent predictors for hypoxia with sensitivity of 70.2%, 50.9% and 75.4%, respectively; and specificity of 88.9%, 96.4%, and 90.9%, respectively. When all three predictors were used in conjunction, the sensitivity increased to 91.2% and specificity was 81.8%. CONCLUSION: No single clinical sign can perform as well as pulse oximetry for predicting hypoxia in children with severe pneumonia. In settings where pulse oximetry is not available, combination of signs, age-specific tachypnea, head nodding, and inability to drink/breastfeeding has acceptable sensitivity and specificity.
Authors: Amanda C Schondelmeyer; Maya L Dewan; Patrick W Brady; Kristen M Timmons; Rhonda Cable; Maria T Britto; Christopher P Bonafide Journal: Pediatrics Date: 2020-07-17 Impact factor: 7.124
Authors: Carina King; Tisungane Mvalo; Kristen Sessions; Iain Wilson; Isabeau Walker; Beatiwel Zadutsa; Charles Makwenda; Tambosi Phiri; Nicholas Boyd; Mike Bernstein; Eric D McCollum Journal: Pediatr Pulmonol Date: 2019-03-25