Predictors of Hypoxemia in Children with Acute Lower Respiratory Tract Infections
Iraqi Postgraduate Medical Journal,
2009, Volume 8, Issue 1, Pages 40-46
Acute lower respiratory tract infections (ALRI) are the leading cause of morbidity and mortality among children in developing countries, causing one – third of all deaths in childhood. Pulse oxymetry is a simple technique to determine the oxygen saturations.
It is important to accurately identify hypoxemic children by use of clinical signs alone.
A well matched case control study was performed on 104 children from 2 months to 5 years of age admitted with ALRI to the emergency department of Children Welfare Teaching Hospital -Medical City - Baghdad in the period from 15thMarch -15thJune 2006.Clinical symptoms and signs were recorded .Hypoxemia was defined as oxygen saturation less than 95%.The ability of various clinical symptoms and signs to predict the presence of hypoxemia was evaluated.
Fifty (48.1%) children were hypoxemic. The median O2 saturation was 91.2%with a range of 82-94% Physical signs including tachypnea, intercostal and subcostal retractions, supraclavicular recessions, grunting and nasal flaring were statistically significantly associated with hypoxemiUse of combinations e.g. Tachypnea or head nodding ( P. 0.02 , sensitivity 70% , specificity 48%),tachypnea or suprasternal recessions( P.0.05 ,sensitivity 70% ,specificity 44%)only slightly improved the predictive ability.
None of the clinical features either alone or in combinations have sufficient sensitively and specificity to predict hypoxemia in children with acute lower respiratory tract infections, therefore pulse oxymetry is desirable for identification of hypoxemia.
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