Which clinical signs predict hypoxaemia in young Senegalese children with acute lower respiratory tract disease?

Paediatr Int Child Health. 2015 Feb;35(1):65-8. doi: 10.1179/2046905514Y.0000000153.


Background: Acute lower respiratory tract diseases are an important cause of mortality in children in resource-limited settings. In the absence of pulse oximetry, clinicians rely on clinical signs to detect hypoxaemia.

Objective: To assess the diagnostic value of clinical signs of hypoxaemia in children aged 2 months to 5 years with acute lower respiratory tract disease.

Methods: Seventy children with a history of cough and signs of respiratory distress were enrolled. Three experienced physicians recorded clinical signs and oxygen saturation by pulse oximetry. Hypoxaemia was defined as oxygen saturation <90%. Clinical predictors of hypoxaemia were evaluated using adjusted diagnostic odds ratios (aDOR).

Results: There was a 43% prevalence of hypoxaemia. An initial visual impression of poor general status [aDOR 20.0, 95% CI 3.8-106], severe chest-indrawing (aDOR 9.8, 95% CI 1.5-65), audible grunting (aDOR 6.9, 95% CI 1.4-25) and cyanosis (aDOR 26.5, 95% CI 1.1-677) were significant predictors of hypoxaemia.

Conclusion: In children under 5 years of age, several simple clinical signs are reliable predictors of hypoxaemia. These should be included in diagnostic guidelines.

Keywords: Acute lower respiratory disease,; Hypoxaemia,; Pulse oximetry; Under-5 children,.

MeSH terms

  • Child, Preschool
  • Clinical Medicine / methods*
  • Female
  • Humans
  • Hypoxia / diagnosis*
  • Hypoxia / pathology*
  • Infant
  • Male
  • Prospective Studies
  • Respiratory Tract Diseases / complications*
  • Respiratory Tract Diseases / pathology
  • Senegal