Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort study

Objectives To determine clinical correlates and outcome of hypoxaemia in ch ildren admitted to hospital with an acute lower respiratory tract infection . Design Prospective cohort study Setting Paediatric wards of the Royal Victoria Hospital and the hospital of the Medical Research Council's hospital in Banjul, the Gambia. Subjects 1072 of 42 848 children, aged 2 to 33 months, who were enrolled in a randomised trial of a Haemophilus influenzae type b vaccine in the weste rn region or the Gambia, and who were admitted with a acute lower respirato ry tract infection to two of three hospitals. Main outcome measures Prevalence of hypoxaemia, defined as an arterial oxyg en saturation < 90% recorded by pulse oximetry, and the relation between hy poxaemia and aetiological agents. Results 1072 children aged 2-33 months were enrolled. Sixty three (5.9%) ha d an arterial oxygen saturation < 90%. A logistic regression model showed t hat cyanosis, a rapid respiratory rate, grunting, head nodding, an absence of a history of fever, and no spontaneous movement during examination were the best independent predictors of hypoxaemia. The presence of an inability to cry, head nodding, or a respiratory rate greater than or equal to 90 br eaths/min formed the best predictors of hypoxaemia (sensitivity 70%, specif icity 79%). Hypoxaemic children were five times more likely to die than non -hypoxaemic children. The presence of malaria parasitaemia had no effect on the prevalence of hypoxaemia or on its association with respiratory rate. Conclusion In children with an acute lower respiratory tract infection, sim ple physical signs that require minimal expertise to recognise can be used to determine oxygen therapy and to aid in screening for referral. The assoc iation between hypoxaemia and death highlights die need for early recogniti on of the condition and the potential benefit of treatment.