The role of pulse oximetry. Its use as an indicator of severe respiratory disease in Peruvian children living at sea level. Respiratory Group in Peru
G. Madico, R. H. Gilman, A. Jabra, L. Rojas, H. Hernandez, J. Fukuda, C. Bern and M. Steinhoff
Asociacion Benefica PRISMA, Lima, Peru.
OBJECTIVE: To evaluate pulse oximetry as a technique for diagnosing
pneumonic and nonpneumonic acute lower respiratory tract infection (ALRI)
in Peruvian children. DESIGN: Children with acute respiratory infection
were diagnosed with hypoxemia by pulse oximetry, with ALRI by the World
Health Organization (WHO) algorithm and clinical examination, and with
pneumonia by radiographic examination. Diagnoses were compared using kappa
analysis. SETTING: Pediatric emergency department. PATIENTS: Peruvian
pediatric patients with acute respiratory infection (n = 269) and well
children (n = 162). MAIN OUTCOME MEASURES: Hypoxemia (arterial oxygen
saturation < 96.6% of the mean arterial oxygen saturation of well
children -2 SD). RESULTS: Children with pneumonic and nonpneumonic ALRI
(59%, 160/269) had a mean (+/- SD) arterial oxygen saturation significantly
lower than well children (93.8% +/- 3.5% vs 98.7% +/- 1.51%; P < .01).
Pulse oximetry detected 88% and the WHO algorithm 90% of cases of pneumonic
ALRI. The WHO algorithm and pulse oximetry detected 72% of radiologic
pneumonia. Pulse oximetry misclassified notably fewer well children than
did the WHO algorithm (4% vs 35%). Pulse oximetry and the WHO algorithm
together (SATWHO) detected 99% and 87% of pneumonic ALRI and radiologic
pneumonias, respectively, and both methods detected 94% of all cases of
pneumonic and nonpneumonic ALRI diagnosed clinically. CONCLUSIONS: Pulse
oximetry and the WHO algorithm are practical, helpful, and appropriate for
use in developing countries to identify children with pneumonic and
non-pneumonic ALRI who require treatment. The SATWHO is highly sensitive
for detecting children with ALRI.
