Can clinical symptoms or signs accurately predict hypoxemia in children with acute lower respiratory tract infections?

Indian Pediatr. 2004 Feb;41(2):129-35.


Objectives: To determine clinical predictors of hypoxemia in children with acute lower respiratory tract infection (ALRI).

Design: Cross-sectional study.

Setting: Emergency department of All India Institute of Medical Sciences, a tertiary care hospital.

Subjects: 109 under five children, with ALRI.

Methods: Clinical symptoms and signs were recorded. Oxygen saturation was determined by a pulse oximeter. Hypoxemia was defined as oxygen saturation less than 90%. The ability of various clinical symptoms and signs to predict the presence of hypoxemia was evaluated.

Results: Twenty-eight (25.7%) children were hypoxemic. No symptoms were statistically associated with hypoxemia. Tachypnea, suprasternal indrawing, intercostal indrawing, lower chest indrawing, cyanosis, crepitations, and rhonchi were statistically significantly associated with hypoxemia. A simple model using the presence of rapid breathing (> or =80/min in children < or =3 m, > or =70/min in >3-12 m and > or =60/min in >12 m) or lower chest indrawing had a sensitivity of 78.5% and specificity of 66.7% for detecting hypoxemia. No individual clinical symptom/sign or a combination had both sufficient sensitivity and specificity to identify hypoxemia.

Conclusion: None of the clinical features either alone or in combination have desirable sensitivity and specificity to predict hypoxemia in children with acute lower respiratory tract infection.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Emergency Service, Hospital
  • Female
  • Humans
  • Hypoxia / diagnosis*
  • Hypoxia / epidemiology
  • Incidence
  • Infant
  • Male
  • Odds Ratio
  • Oximetry
  • Predictive Value of Tests
  • Pulmonary Gas Exchange
  • Respiratory Function Tests
  • Respiratory Tract Infections / diagnosis*
  • Respiratory Tract Infections / epidemiology
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index