Which clinical signs predict hypoxaemia in young Senegalese children with acute lower respiratory tract disease?

Wandeler, Gilles; Pauchard, J Y; Zangger, E; Diawara, H; Gehri, M (2015). Which clinical signs predict hypoxaemia in young Senegalese children with acute lower respiratory tract disease? Paediatrics and international child health, 35(1), pp. 65-68. Maney Publishing 10.1179/2046905514Y.0000000153

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BACKGROUND

Acute lower respiratory tract diseases are an important cause of mortality in children in resource-limited settings. In the absence of pulse oximetry, clinicians rely on clinical signs to detect hypoxaemia.

OBJECTIVE

To assess the diagnostic value of clinical signs of hypoxaemia in children aged 2 months to 5 years with acute lower respiratory tract disease.

METHODS

Seventy children with a history of cough and signs of respiratory distress were enrolled. Three experienced physicians recorded clinical signs and oxygen saturation by pulse oximetry. Hypoxaemia was defined as oxygen saturation <90%. Clinical predictors of hypoxaemia were evaluated using adjusted diagnostic odds ratios (aDOR).

RESULTS

There was a 43% prevalence of hypoxaemia. An initial visual impression of poor general status [aDOR 20·0, 95% CI 3·8-106], severe chest-indrawing (aDOR 9·8, 95% CI 1·5-65), audible grunting (aDOR 6·9, 95% CI 1·4-25) and cyanosis (aDOR 26·5, 95% CI 1·1-677) were significant predictors of hypoxaemia.

CONCLUSION

In children under 5 years of age, several simple clinical signs are reliable predictors of hypoxaemia. These should be included in diagnostic guidelines.

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