Abstract
Background
Current WHO algorithm has retained the signs and symptoms used in the older version for classifying severity of childhood pneumonia.
Objective
To study the role of clinical features (including that of current WHO criteria), and oxygen saturation (SpO2) in the diagnosis of childhood pneumonia.
Study design
Multicenter prospective cohort study.
Participants
Children, 2 to 59 months of age, suffering from acute respiratory infection (ARI).
Outcome measures
Sensitivity, specificity, and likelihood ratios were calculated for clinical features, and SpO2.
Results
Of a total 7026 children with ARI enrolled, 13.4% had pneumonia (37% of them had severe pneumonia), according to WHO criteria. 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 >80%. Audible wheeze and breathing difficulty, each had a specificity of >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 >80%. Addition of SpO2 of <92% to chest indrawing alone or WHO criteria increased the likelihood of diagnosis of pneumonia.
Conclusions
Current WHO criteria based on rapid respiratory rate and/or chest indrawing has modest sensitivity and specificity, considering CXR abnormalities as gold standard for diagnosis of pneumonia. Addition of SpO2 of <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.
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Acknowledgements
AIIMS Bhubaneswar: Ms Jyotshnarani Sahoo and Ms Manaswini Biswal; AIIMS Jodhpur: Mr Vikas Patwa; KIMS Hubli: Dr Prakash Wari (HOD Pediatrics), Vedasree and Gayatri; SKIMS Srinagar: Umaisa Zehra and Saba.
Funding
Funding: This work was supported by Bill and Melinda Gates Foundation through The INCLEN Trust International (Grant number: OPP1084307). The funding source had no contribution in study design, implementation, collection and interpretation of data and report writing.
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RRD: involved in protocol development, supervision of study, data collection and analysis, and manuscript writing. AKS: involved in data collection, management of patients, and manuscript writing. AM, RL: involved in protocol development, data analysis, and manuscript writing. JPG, JIB, VHR, BV: involved in protocol development, and manuscript writing. All the authors have approved the manuscript version to be published.
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The study was approved by Institutional ethics committee of all the six study sites.
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List of ATU Group members provided in annexure I.
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Das, R.R., Satapathy, A.K., Mukherjee, A. et al. Role of Clinical Criteria and Oxygen Saturation Monitoring in Diagnosis of Childhood Pneumonia in Children Aged 2 to 59 Months. Indian Pediatr 58, 1024–1029 (2021). https://doi.org/10.1007/s13312-021-2367-3
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DOI: https://doi.org/10.1007/s13312-021-2367-3