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

Abstract

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.

Keywords:

• Under-5 children
• Acute lower respiratory disease
• Hypoxaemia
• Pulse oximetry

Acknowledgments

The authors thank Dr P. K. Gaye of Ndioum Hospital, Dr Ch. Hanne of Podor Département, Senegal, Dresse Céline Fischer-Fumeaux, DMCP, CHUV-Lausanne, Professor D. Sow, former medical chief of Pediatrics, Dakar, Sénégal for their time and support.