CARETAKER RECOGNITION OF RESPIRATORY SIGNS IN CHILDREN - CORRELATION WITH PHYSICAL-EXAMINATION FINDINGS, X-RAY-DIAGNOSIS AND PULSE OXIMETRY

Caretaker recognition and clinical utility of respiratory signs and sy mptoms in the prediction of pneumonia was examined in a prospective st udy of infants and children in four cities in Egypt. In all 688 childr en aged 2 months-5 years presenting with a history and/or physical exa mination findings of cough and difficult or fast breathing were recrui ted from outpatient health facilities. The validity of caretaker terms was determined using paediatrician observation of standard respirator y signs and symptoms, x-ray diagnosis and pulse oximetry as standards. The sensitivity of 'nahagan' (Egyptian Arabic for fast breathing) for identifying elevated respiratory rate was 78% +/- 4, and was slightly higher for <12 month olds (85% +/- 5) versus children aged 1-5 years (74% +/- 5). 'Sedro tale nazel', which describes the chest as moving u p and down, was a sensitive (86% +/- 3) and specific (60% +/- 4) indic ator of chest indrawing. 'Tazyeek' (wheeze) had a sensitivity of 75% /- 3 and specificity of 66% +/- 4 when compared to paediatrician asses sment of wheezing during physical examination. Although not specific, the caretaker terms, 'nahagan' or 'nafas seria' (fast breathing) and ' sedro tale nazel' (chest indrawing), either spontaneously or after ask ing, were sensitive (>71%) indicators of radiologic pneumonia and oxyg en desaturation, and therefore can be used to prompt timely health see king behaviour in these settings.