Clinical predictors of hypoxemia in Indian children with acute respiratory tract infection presenting to pediatric emergency department

Rao, Yashwant Kumar; Midha, Tanu; Kumar, Pankaj; Tripathi, Virendra Nath; Prakash, Om

doi:10.1007/s12519-012-0365-1

Cited by 17 publications

(20 citation statements)

References 11 publications

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“…14 The prevalence of hypoxemia documented in various studies with a variation. The present study showed 48%, the prevalence of hypoxemia was more [14][15][16][17] when compared to earlier studies in India. There were 24.4% female and 75.6% male children found without hypoxemia as compared to 37.5% female and 62.5% male children had hypoxemia but the gender differences between groups were statistically insignifi cant which was supported by Motwani et al (2015) 10 observed that the difference between male and females, as regarding to prevalence of hypoxemia was not signifi cant.…”

Section: Discussioncontrasting

confidence: 45%

“…12 Findings of the study revealed that grunting (p=0.009), nasal fl aring (p=0.008), subcostal (p=0.001) and intercostal (p=0.000) retractions were highly but suprasternal retraction was signifi cantly (p=0.024) associated with hypoxemia which is in agreement with various other studies have reported that grunting and nasal fl aring were signifi cantly associated with hypoxemia. 1,18,23 During a study, Rao et al (2012) 16 found that chest wall retraction was found to be the most sensitive indicator, and cyanosis was the most specifi c indicator for hypoxemia. Kuti has also confi rmed the relevance of the study as he recently reported that children that grunt and are centrally cyanosed should preferentially commenced on oxygen therapy even when there is no facility to confi rm hypoxemia.…”

Section: Discussionmentioning

confidence: 99%

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Determinants of hypoxemia in children associated with pneumonia

Ramawat

Sharma

2015

Asian J Med Sci

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Background and Objectives:The most severe manifestation of pneumonia is hypoxemia has been shown to be a risk factor for morbidity and mortality. Authors investigated associating factors and determinants of hypoxemia in children with pneumonia. Materials and Methods: A crosssectional study is designed among children of pediatric outpatient and emergency department that enrolled at Government Multi-Speciality Hospital, Chandigarh. One hundred fi fty children recruited for study. The demographic and clinical parameters were recorded. Oxygen saturation measured by pulse oximeter. Results: The prevalence of hypoxemia was 48% and 61 (84.7%) infants aged 1 year found with hypoxemia. Age (p=0.006), respiratory rate (p=0.001) and severity of pneumonia (p=0.001) were strongly associated with hypoxemia. The prevalence of severe and very severe pneumonia among hypoxemic were 56.1% and 73.7% respectively. Central cyanosis (98.7%), peripheral (98.7%) cyanosis, head nodding (97.4%) grunting (96.15%) were highly specifi c but suprasternal (62.82%), subcostal (43.58%) and intercostal retractions (44.87%) were fairly specifi c sign. Sensitivity for subcostal (81.94%) and intercostal retractions (83.33%) was very high but was fair for intercostal (83.33%) retraction. Grunting (p=0.009), nasal fl aring (p=0.008), subcostal (p=0.001) and intercostal (p=0.000) retractions were strongly but suprasternal retraction was signifi cantly (p=0.024) associated with hypoxemia. Dyspnea (97.22%) was very sensitive while decrease feeding (84.61%) and irritability (83.33%) was highly but lethargy (58.97%) was fairly specifi c symptom. Conclusions: Study suggested that clinical signs and symptoms such as chest wall retraction, decrease feeding, dyspnea, grunting and nasal fl aring in children with pneumonia may be utilized as markers for hypoxemia in conditions where pulse-oximeter isn't available. This study supports the view of hypoxemia was disabling factor in better functional recovery in severity of pneumonia.

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Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Determinants of hypoxemia in children associated with pneumonia

Ramawat

Sharma

2015

Asian J Med Sci

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“…inability to feed or drink or cyanosis or respiratory rate >70 breaths/min or severe chest indrawing) are a sensitive combination of clinical signs, although its moderate specificity could be problematic in limited‐resource settings due to the risk of wasting oxygen treating non‐hypoxaemic children . There is no consensus on whether to prioritize sensitivity or specificity of the variables used to build combined models .…”

Section: Introductionmentioning

confidence: 99%

Hypoxaemia in Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models

Bassat

Lanaspa

Machevo

et al. 2016

Tropical Med Int Health

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Abstractobjective To determine the prevalence of hypoxaemia among under-five children admitted to hospital with clinical severe pneumonia and to assess the performance to diagnose hypoxaemia of models based on clinical signs.methods We conducted a hospital-based survey in a district hospital from Southern Mozambique. results A total of 825 children were recruited after obtaining an informed consent. The prevalence of hypoxaemia on admission was 27.9%, and 19.8% of these children died (OR compared with nonhypoxaemic children 3.22, 95% CI 1.98-5.21, P < 0.001). The model with larger area under the ROC curve (AUC-ROC) to predict hypoxaemia included cyanosis or thoracoabdominal breathing or respiratory rate ≥70 breaths per minute. None of the models performed well when tested in different case scenarios of oxygen availability through mathematical modelling, with over 50% of hypoxaemic children not receiving oxygen even in favourable case scenarios.conclusions Clinical signs alone or in combination are not suitable to diagnose hypoxaemia. The use of pulse oximeters should be strongly encouraged.

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“…2 To date, no consensus has been reached on the importance of specific clinical predictors of hypoxaemia in children with acute respiratory disease, despite the publication of several reports on the subject. [2][3][4][5][6][7] In their systematic review and meta-analysis of the accuracy of symptoms and signs in predicting hypoxaemia in children, Zhang et al found only 11 studies and there was high Heterogeneity in the results across the studies. 8 As the administration of oxygen is of primary importance in these situations, hypoxaemia has to be detected rapidly.…”

Section: Introductionmentioning

confidence: 99%