A comparative study of clinical signs versus pulse oximetry for prediction of hypoxia in very severe pneumonia in children
DOI:
https://doi.org/10.18203/2349-3291.ijcp20242675Keywords:
Very severe pneumonia, Pediatric hypoxia, Pulse oximetry, Clinical signs, Respiratory distressAbstract
Background: Severe pneumonia is a leading cause of pediatric mortality, especially in developing countries. Hypoxia, a common complication, requires accurate and timely detection. Traditional clinical signs and the more recent pulse oximetry are both used to predict hypoxia, but their comparative effectiveness in very severe pneumonia is not well-established.
Methods: This cross-sectional observational study was conducted at SPMCHI Hospital, SMS Medical College, Jaipur, from September 2019 to May 2020. It involved 150 children aged 2 months to 5 years, diagnosed with very severe pneumonia per F-IMNCI guidelines. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of clinical signs versus pulse oximetry in predicting hypoxia.
Results: Of the 150 children, 67.3% were aged 2–12 months. Hypoxia was more prevalent in this age group (58.4%) compared to children older than 12 months (40.8%) (p=0.042). Gender did not significantly affect hypoxia incidence. Pulse oximetry showed higher specificity and sensitivity compared to clinical signs alone, with respiratory rates ≥70/min providing the highest specificity (92.6%).
Conclusions: Pulse oximetry provides a more reliable diagnostic tool for predicting hypoxia in children with very severe pneumonia compared to traditional clinical signs, suggesting a need for broader implementation in resource-limited settings.
References
Duke T, Subhi R, Peel D, Frey B. Pulse oximetry: Technology to reduce child mortality in developing countries. Ann Trop Paediatr. 2010;30(3):165-75.
Graham H, Bakare AA, Gray A, Ayede AI, Qazi S, McPake B, et al. Adoption of pulse oximetry in the management of World Health Organization-defined pneumonia in hospitalized children in Nigeria: A case-control study. Lancet Global Health. 2018;6(3).
Lodha R, Kabra SK, Pandey RM. Antibiotics for community-acquired pneumonia in children. Cochrane Database Syst Rev. 2013;2013(6):CD004874.
McCollum ED, Colbourn T. Pneumonia's second wind? A case study of the global health network for childhood pneumonia. Health Policy and Planning. 2019;34(1).
Mulholland K, Cherian T. Standards for Development and Evaluation of the use of pneumonia diagnostic aids for use in low and middle income settings. Trop Med Int Health. 2005;10(6):697-702.
Onyango D, Kikuvi G, Amukoye E, Omolo J. Hypoxaemia in young Kenyan children with acute lower respiratory infection. BMJ Open. 2012;2(2).
Qazi S, Aboubaker S, MacLean R, Fontaine O, Mantel C, Goodman T, et al. Ending preventable child deaths from pneumonia and diarrhoea by 2025. The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). Lancet. 2013;381(9876):1405-6.
Rambaud-Althaus C, Althaus F, Genton B, D'Acremont V. Clinical features for diagnosis of pneumonia in children younger than 5 years: A systematic review and meta-analysis. Lancet Infect Dis. 2015;15(4):439-50.
Subhi R, Adamson M, Campbell H, Weber M, Smith K, Duke T. The prevalence of hypoxia among children with pneumonia: A systematic review. Lancet Infect Dis. 2009;9(4):219-27.
Usen S, Weber M, Mulholland K, Jaffar S, Oparaugo A, Omosigho C. Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: Prospective cohort study. BMJ. 1999;318(7176):86-91.
Weber MW, Usen S, Palmer A, Jaffar S, Mulholland EK. Predictors of hypoxia in hospital admissions with acute lower respiratory tract infection in a developing country. Arch Dis Childhood. 1997;76(4):310-4.
World Health Organization. Revised WHO classification and treatment of childhood pneumonia at health facilities: Evidence summaries. 2013. Available at: https://www.who.int/publications/i/ item/9789241507813. Accessed on 15 May 2024.
Zar HJ, Jeena P, Argent A, Gie R, Madhi SA. Diagnosis and management of community-acquired pneumonia in children - South African Thoracic Society Guidelines. South Afr Med J. 2005;95(12):977-81.
Zar HJ, Pollock L, Swingler G, van der Merwe L. Diagnostic accuracy of clinical symptoms and signs in children with pneumonia. South Afr Med J. 2011;101(3):146-9.
