International Emergency Medicine OXYGEN SATURATION CAN PREDICT PEDIATRIC PNEUMONIA IN A RESOURCE-LIMITED SETTING (original) (raw)
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Oxygen Saturation Can Predict Pediatric Pneumonia in a Resource-Limited Setting
The Journal of Emergency Medicine, 2013
Background: The World Health Organization (WHO) recommends using age-specific respiratory rates for diagnosing pneumonia in children. Past studies have evaluated the WHO criteria with mixed results. Objective: We examined the accuracy of clinical and laboratory factors for diagnosing pediatric pneumonia in resourcelimited settings. Methods: We conducted a retrospective chart review of children under 5 years of age presenting with respiratory complaints to three rural hospitals in Rwanda who had received a chest radiograph. Data were collected on the presence or absence of 31 historical, clinical, and laboratory signs. Chest radiographs were interpreted by pediatric radiologists as the gold standard for diagnosing pneumonia. Overall correlation and test characteristics were calculated for each categorical variable as compared to the gold standard. For continuous variables, we created receiver operating characteristic (ROC) curves to determine their accuracy for predicting pneumonia. Results: Between May 2011 and April 2012, data were collected from 147 charts of children with respiratory complaints. Approximately 58% of our sample had radiologist-diagnosed pneumonia. Of the categorical variables, a negative blood smear for malaria (c 2 = 6.21, p = 0.013) and the absence of history of asthma (c 2 = 4.48, p = 0.034) were statistically associated with pneumonia. Of the continuous variables, only oxygen saturation had a statistically significant area under the ROC curve (AUC) of 0.675 (95% confidence interval [CI] 0.581-0.769 and p = 0.001). Respiratory rate had an AUC of 0.528 (95% CI 0.428-0.627 and p = 0.588). Conclusion: Oxygen saturation was the best clinical predictor for pediatric pneumonia and should be further studied in a prospective sample of children with respiratory symptoms in a resourcelimited setting. Ó 2013 Elsevier Inc.
Prediction of Pneumonia in a Pediatric Emergency Department
PEDIATRICS, 2011
WHAT'S KNOWN ON THIS SUBJECT: Use of chest radiography in the evaluation of children with possible pneumonia varies widely. Although studies have identified certain historical features and physical examination findings associated with pneumonia, none have specifically addressed the criteria for obtaining a chest radiograph.
Aim: To identify clinical parameters other than respiratory rate which are simple and equally predictive ofpneumonia in under five children. Patients and Method: One,hundred and one children with f, J!Spiratory symptoms s 28 days were studied. Detailed history, physical examination and chest radiography were done on each child. Data was analyzed using the EPI-INFO version' 5 software. Results: A combination of history of difficult breathing and/or observation of chest in-drawing was the best predictor of pneumonia in all age groups studied (75% sensitivity, 80% positive predictive value). Conclusion: · We suggest that the current WHO guideline on the use of respiratory rate to predict pneumonia be expanded to include history of difficult breathing and/or observation of chest in-drawing as major criteria for predicting pneumonia in under five . children.
An analysis of clinical predictive values for radiographic pneumonia in children
BMJ Global Health
IntroductionHealthcare providers in resource-limited settings rely on the presence of tachypnoea and chest indrawing to establish a diagnosis of pneumonia in children. We aimed to determine the test characteristics of commonly assessed signs and symptoms for the radiographic diagnosis of pneumonia in children 0–59 months of age.MethodsWe conducted an analysis using patient-level pooled data from 41 shared datasets of paediatric pneumonia. We included hospital-based studies in which >80% of children had chest radiography performed. Primary endpoint pneumonia (presence of dense opacity occupying a portion or entire lobe of the lung or presence of pleural effusion on chest radiograph) was used as the reference criterion radiographic standard. We assessed the sensitivity, specificity, and likelihood ratios for clinical findings, and combinations of findings, for the diagnosis of primary endpoint pneumonia among children 0–59 months of age.ResultsTen studies met inclusion criteria com...
Tropical Medicine & International Health, 2015
objective Cough or difficult breathing and an increased respiratory rate for their age are the commonest indications for outpatient antibiotic treatment in African children. We aimed to determine whether respiratory rate was likely to be transiently raised by a number of contextual factors in a busy clinic leading to inaccurate diagnosis. methods Respiratory rates were recorded in children aged 2-59 months presenting with cough or difficulty breathing to one of the two busy outpatient clinics and then repeated at 10-min intervals over 1 h in a quiet setting. results One hundred and sixty-seven children were enrolled with a mean age of 7.1 (SD AE 2.9) months in infants and 27.6 (SD AE 12.8) months in children aged 12-59 months. The mean respiratory rate declined from 42.3 and 33.6 breaths per minute (bpm) in the clinic to 39.1 and 32.6 bpm after 10 min in a quiet room and to 39.2 and 30.7 bpm (P < 0.001) after 60 min in younger and older children, respectively. This resulted in 11/13 (85%) infants and 2/15 (13%) older children being misclassified with non-severe pneumonia. In a random effects linear regression model, the variability in respiratory rate within children (42%) was almost as much as the variability between children (58%). Changing the respiratory rates cutoffs to higher thresholds resulted in a small reduction in the proportion of non-severe pneumonia mis-classifications in infants. conclusion Noise and other contextual factors may cause a transient increase in respiratory rate and consequently misclassification of non-severe pneumonia. However, this effect is less pronounced in older children than infants. Respiratory rate is a difficult sign to measure as the variation is large between and within children. More studies of the accuracy and utility of respiratory rate as a proxy for non-severe pneumonia diagnosis in a busy clinic are needed. keywords pneumonia, respiratory rate, children, Integrated
Journal of Global Health
Background Existing scores to identify children at risk of hospitalized pneumonia-related mortality lack broad external validation. Our objective was to externally validate three such risk scores. Methods We applied the Respiratory Index of Severity in Children (RISC) for HIV-negative children, the RISC-Malawi, and the Pneumonia Etiology Research for Child Health (PERCH) scores to hospitalized children in the Pneumonia REsearch Partnerships to Assess WHO REcommendations (PREPARE) data set. The PREPARE data set includes pooled data from 41 studies on pediatric pneumonia from across the world. We calculated test characteristics and the area under the curve (AUC) for each of these clinical prediction rules. Results The RISC score for HIV-negative children was applied to 3574 children 0-24 months and demonstrated poor discriminatory ability (AUC = 0.66, 95% confidence interval (CI) = 0.58-0.73) in the identification of children at risk of hospitalized pneumonia-related mortality. The RISC-Malawi score had fair discriminatory value (AUC = 0.75, 95% CI = 0.74-0.77) among 17 864 children 2-59 months. The PERCH score was applied to 732 children 1-59 months and also demonstrated poor discriminatory value (AUC = 0.55, 95% CI = 0.37-0.73). Conclusions In a large external application of the RISC, RISC-Malawi, and PERCH scores, a substantial number of children were misclassified for their risk of hospitalized pneumonia-related mortality. Although pneumonia risk scores have performed well among the cohorts in which they were derived, their performance diminished when externally applied. A generalizable risk assessment tool with higher sensitivity and specificity to identify children at risk of hospitalized pneumonia-related mortality may be needed. Such a generalizable risk assessment tool would need context-specific validation prior to implementation in that setting.
IOSR Journals , 2019
Background: Pneumonia accounts for a significant proportion of the disease burden attributed to acute lower respiratory infections.In order to optimise criteria for hospitalisation and initial therapy, use of Acute Illness Observation Scale (AIOS)-a simple and objective illness severity scale is validated using pulse oximetry and radiological findings. Methods:All children between 2-24 months, admitted to the children ward with suspected pneumonia were enrolled into the study. Pulse oximetry reading on admission was noted. Acute Illness Observation Scale scoring used to score severity of illness at admission and after 24 hours and 96 hours of admission. Patients were followed up till the time of discharge from hospital / death. Results wereanalysed for the extent to which chest X-ray and pulse oximetry readings correlate to the AIOS score thereby indicating severity of pneumonia. Results:In infants pulse oximeter reading<85% better predicted endpoint consolidation and complications.Pulse oximeter reading<92% is more specific (90%) in children with more than 12 months age for predicting endpoint consolidation in x-ray than in infants. AIOS score correlated well with Pulse oximeter readings (p<0.01, Karl Pearson correlation =-0.65) and abnormal X-ray findings (p<0.01, Karl Pearson correlation = 0.46). AIOS score>10 is more sensitive and less specific in predicting abnormal X-ray than pulse oximetry alone. AIOS score>15 is significantly associated with poor clinical course, complications, prolonged hospital stay and culture positive pneumonia. Conclusion:AIOS scoring can be used by the treating physician not only in deciding on therapeutic modalities but also to prognosticate a child admitted to the hospital with pneumonia with an approximate duration of hospital stay that may be required.
Incorporation of biomarkers into a prediction model for paediatric radiographic pneumonia
ERJ Open Research
ObjectiveTo evaluate biomarkers to predict radiographic pneumonia among children with suspected lower respiratory tract infections (LRTI).MethodsWe performed a single-center prospective cohort study of children 3 months to 18 years evaluated in the emergency department with signs and symptoms of LRTI. We evaluated the incorporation of four biomarkers (white blood cell count (WBC), absolute neutrophil count (ANC), C-reactive protein (CRP), and procalcitonin), in isolation and in combination, with a previously developed clinical model (which included focal decreased breath sounds, age, and fever duration) for an outcome of radiographic pneumonia using multivariable logistic regression. We evaluated the improvement in performance of each model with the concordance (c-)index.ResultsOf 580 included children, 213 (36.7%) had radiographic pneumonia. In multivariable analysis, all biomarkers were statistically associated with radiographic pneumonia, with CRP having the greatest adjusted odd...
Clinical predictors of hypoxemia in 1-5 year old children with pneumonia
Paediatrica Indonesiana, 2016
Background Pneumonia remains a major killer of under five children. Hypoxemia is the most serious manifestation of pneumonia. The most reliable way to detect hypoxemia is an arterial blood analysis or SPar However, these tools are not widely available; therefore, a simple clinical manifestation should be used as an alternative.Objective To determine clinical predictors of hypoxemia in 1-5 year-old children with pneumonia in Indonesia.Methods This study was conducted between February 2007 to August 2008 at Sanglah Hospital, Denpasar, Bali. Sample was selected using a convenient sampling method. Subjects were divided into group of hypoxemia and nonnal saturation. We did clinical examination and SpOz measurement, as the gold standard, simultaneously.Results From 120 subjects" the prevalence of hypoxemia was 17.5%. The best single clinical predictors of hypoxemia was cyanosis (sensitivity 43%, specificity 99%, positive predictive value (PPV) 90%, negative predictive value (NPV) 89...
Determinants of Oxygen Therapy in Childhood Pneumonia in a Resource-Constrained Region
ISRN Pediatrics, 2013
Childhood pneumonia is a leading cause of morbidity and mortality among underfives particularly in the resource-constraint part of the world. A high proportion of these deaths are due to lack of oxygen, thereby making oxygen administration a life-saving adjunctive when indicated. However, many primary health centres that manage most of the cases often lack the adequate manpower and facilities to decide which patient should be on oxygen therapy. Therefore, this study aimed to determine factors that predict hypoxaemia at presentation in children with severe pneumonia. Four hundred and twenty children aged from 2 to 59 months (40% infants) with severe pneumonia admitted to a health centre in rural Gambia were assessed at presentation. Eighty-one of them (19.30%) had hypoxaemia (oxygen saturation < 90%). Children aged 2–11 months, with grunting respiration, cyanosis, and head nodding, and those with cardiomegaly on chest radiograph were at higher risk of hypoxaemia (P<0.05). Grunt...