Role of clinical criteriaa and oxygen saturation (SpO2) monitoring in the diagnosis of pneumonia in children aged 2 to 59 months

Abstract

<b>Background:</b> Current WHO algorithm has retained the signs and symptoms used in the older version for classifying severity of childhood pneumonia. <b>Objective:</b> To study the role of clinical features (including that of current WHO criteria), and oxygen saturation (SpO2) in the diagnosis of childhood pneumonia. <b>Methods:</b> This multicenter prospective cohort study was conducted at six sites in India. Sensitivity, specificity, and likelihood ratios were calculated for clinical features, and SpO2. <b>Results:</b> Of a total 7026 children with ARI enrolled, 13.4% had pneumonia (37% of them had severe pneumonia), according to WHO criteria (Figure 1). Based on any abnormality on chest x ray (CXR), 46% had pneumonia. The sensitivity and specificity of the existing WHO criteria for diagnosis of pneumonia was 56.5% and 66.2%, respectively, when compared against abnormalities in CXR. Cough and fever, each had sensitivity of &gt;80%. Audible wheeze and breathing difficulty, each had a specificity of &gt;80%. Sensitivity and specificity of tachypnoea were 58.7% and 63.3%, respectively. None of the clinical features alone had a sensitivity and specificity of &gt;80%. Addition of SpO2 of &lt;92% to chest indrawing alone or WHO criteria increased the likelihood of diagnosis of pneumonia. <b>Conclusions:</b> Addition of SpO2 of &lt;92% to chest indrawing alone or WHO criteria increases the probability of pneumonia diagnosis, and is important in the management of a child with pneumonia.