PREDICTORS OF HYPOXEMIA IN-HOSPITAL ADMISSIONS WITH ACUTE LOWER RESPIRATORY-TRACT INFECTION IN A DEVELOPING-COUNTRY

Since oxygen has to be given to most children in developing countries on the basis of clinical signs without performing blood gas analyses, possible clinical predictors of hypoxaemia were studied. Sixty nine ch ildren between the ages of 2 months and 5 years admitted to hospital w ith acute lower respiratory tract infection and an oxygen saturation ( SaO(2)) < 90% were compared with 67 children matched for age and diagn osis from the same referral hospital with an SaO(2) of 90% or above (c ontrol group 1), and 44 unreferred children admitted to a secondary ca re hospital with acute lower respiratory infection (control group 2). Using multiple logistic regression analysis, sleepiness, arousal, qual ity of cry, cyanosis, head nodding, decreased air entry, nasal flaring , and upper arm circumference were found to be independent predictors of hypoxaemia on comparison of the cases with control group 1. Using a simple model of cyanosis or head nodding or not crying, the sensitivi ty to predict hypoxaemia was 59%, and the specificity 94% and 93% comp ared to control groups 1 and 2, respectively; 80% of the children with an SaO(2) < 80% were identified by the combination of these signs. Ov er half of the children with hypoxaemia could be identified with a com bination of three signs: extreme respiratory distress, cyanosis, and s everely compromised general status. Further prospective validation of this model with other datasets is warranted. No other signs improved t he sensitivity without compromising specificity. If a higher sensitivi ty is required, pulse oximetry has to be used.