THE ROLE OF PULSE OXIMETRY - ITS USE AS AN INDICATOR OF SEVERE RESPIRATORY-DISEASE IN PERUVIAN CHILDREN LIVING AT SEA-LEVEL

Objective: To evaluate pulse oximetry as a technique for diagnosing pn eumonic and nonpneumonic acute lower respiratory tract infection (ALRI ) in Peruvian children. Design: Children with acute respiratory infect ion were diagnosed with hypoxemia by pulse oximetry, with ALRI by the World Health Organization (WHO) algorithm and clinical examination, an d with pneumonia by radio-graphic examination. Diagnoses were compared using K analysis. Setting: Pediatric emergency department. Patients: Peruvian pediatric patients with acute respiratory infection (n=269) a nd well children (n=162). Main Outcome Measures: Hypoxemia (arterial o xygen saturation <96.6% of the mean arterial oxygen saturation of well children -2 SD). Results: Children with pneumonic and nonpneumonic AL RI (59%, 160/269) had a mean (+/-SD) arterial oxygen saturation signif icantly lower than well children (93.8% +/- 3.5% vs 98.7% +/- 1.51%; P <.01). Pulse oximetry detected 88% and the WHO algorithm 90% of cases of pneumonic ALRI. The WHO algorithm and pulse oximetry detected 72% o f radiologic pneumonia. Pulse oximetry misclassified notably fewer wel l children than did the WHO algorithm (4% vs 35%). Pulse oximetry and the WHO algorithm together (SATWHO) detected 99% and 87% of pneumonic ALRI and radiologic pneumonias, respectively, and both methods detecte d 94% of all cases of pneumonic and nonpneumonic ALRI diagnosed clinic ally. Conclusions: Pulse oximetry and the WHO algorithm are practical, helpful, and appropriate for use in developing countries to identify children with pneumonic and nonpneumonic ALRI who require treatment. T he SATWHO is highly sensitive for detecting children with ALRI.