Hypoxaemia in Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models.
Bassat, Quique;
Lanaspa, Miguel;
Machevo, Sónia;
O'Callaghan-Gordo, Cristina;
Madrid, Lola;
Nhampossa, Tacilta;
Acácio, Sozinho;
Roca, Anna;
Alonso, Pedro L;
(2016)
Hypoxaemia in Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models.
Tropical medicine & international health, 21 (9).
pp. 1147-1156.
ISSN 1360-2276
DOI: https://doi.org/10.1111/tmi.12738
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OBJECTIVE: 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 non-hypoxaemic 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.