Papers

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

Stanley Usen, research clinician, ^a Martin Weber, research clinician, ^b Kim Mulholland, paediatrician, ^b Shabbar Jaffar, unit statistician, ^a Anslem Oparaugo, research clinician, ^a Charles Omosigho, research clinician, ^a Richard Adegbola, microbiologist, ^a Brian Greenwood, director. ^c

^a Medical Research Council Laboratories, PO Box 273, Fajara, Gambia, ^b Global Programme on Vaccine and Immunisation, World Health Organisation, 1211 Geneva 27, Switzerland, ^c London School of Hygiene and Tropical Medicine, London WC1E 7HT

Correspondence to: Dr Usen susen{at}mrc.enda.sn

Objectives: To determine clinical correlates and outcome of hypoxaemia in children 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 western region of the Gambia, and who were admitted with an acute lower respiratory tract infection to two of three hospitals.
Main outcome measures: Prevalence of hypoxaemia, defined as an arterial oxygen saturation <90% recorded by pulse oximetry, and the relation between hypoxaemia and aetiological agents.
Results: 1072 children aged 2-33 months were enrolled. Sixty three (5.9%) had an arterial oxygen saturation <90%. A logistic regression model showed that 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 90 breaths/min formed the best predictors of hypoxaemia (sensitivity 70%, specificity 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, simple physical signs that require minimal expertise to recognise can be used to determine oxygen therapy and to aid in screening for referral. The association between hypoxaemia and death highlights the need for early recognition of the condition and the potential benefit of treatment.