An Observational Study of the Risk Assessment of Severe Pneumonia for Prediction of Hypoxemia by Pulse Oximetry

Background: Severe pneumonia in children has a grave prognosis. Clinical presentations and hypoxemia have shown a significant association with mortality.  Objectives: We aimed to determine the risk association between pulse oximetry and clinical parameters. Methods: This observational cross-sectional study was conducted from March ۲۰۱۸ to December ۲۰۱۹. The children (aged ۲ months to ۵ years) diagnosed with severe pneumonia or very severe disease based on IMNCI (Integrated Management of Neonatal and Childhood Illness) guidelines were consecutively selected. Hypoxemia was defined as oxygen saturation less than ۹۰%. We used univariate and multivariate logistic regression to determine the odds ratio of variables to predict hypoxemia. Accordingly, sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of signs and symptoms were calculated to predict hypoxemia. Results: Of ۴۰۰ children enrolled in the study, ۱۵۹ children (۳۹.۷۵%) were hypoxemic. Cough, cyanosis, intercostal retractions, nasal flaring, grunting, and lethargy were independent risk factors of hypoxemia with an adjusted odds ratio of ۳.۱۳, ۲۱۳.۵۶۲, ۲۹.۱۷۸, ۵۷.۷۶۲, ۱۷۹.۶۴۸, and ۱۹.۴۱۷, respectively. Predictors with a high sensitivity for hypoxemia were breathing difficulty (۹۹.۳۷%), intercostal retractions (۹۸.۶۴%), subcostal retractions (۹۸.۷۶%), nasal flaring (۹۹.۳۷%), lethargy (۹۶.۸۶%), and crepitations (۹۹.۸۷%). Predictors with high specificity were convulsion (۹۸.۵۳%), cyanosis (۹۷.۹۹%), suprasternal retractions (۹۹.۵۹%), grunting (۹۷.۷۸%), and head nodding (۹۹.۱۷%). Conclusions: The study provides conclusive results of the risk association of clinical features in predicting hypoxemia in children with severe pneumonia. The easy use of pulse oximeter and significant association of clinical features with hypoxemia may be helpful in better categorization, diagnosis, and management of children with severe pneumonia.

کلیدواژه ها:

Clinical features ، Pulse oximetry ، Severe pneumonia ، Hypoxemia ، Risk association