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Its Use as an Indicator of Severe Respiratory Disease in Peruvian Children Living at Sea Level

Guillermo Madico, MD; Robert H. Gilman, MD; Amal Jabra, MD; Lilia Rojas, MD; Herminio Hernández, MD; Juan Fukuda, MD; Caryn Bern, MD, MPH; Mark Steinhoff, MD

Arch Pediatr Adolesc Med. 1995;149(11):1259-1263.

Abstract
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 radio-graphic examination. Diagnoses were compared using 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 nonpneumonic ALRI who require treatment. The SATWHO is highly sensitive for detecting children with ALRI.

(Arch Pediatr Adolesc Med. 1995;149:1259-1263)

Author Affiliations
From Asociación Benéfica PRISMA, Lima, Peru (Drs Madico, Gilman, and Rojas); Faculties of Science (Dr Madico) and Medicine (Drs Gilman, Rojas, Hernández, and Fukuda), Universidad Peruana Cayetano Heredia, Lima; School of Hygiene (Drs Gilman and Steinhoff) and Medicine (Dr Jabra), The Johns Hopkins University, Baltimore, Md; and the Division of Nutrition, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Bern).

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