THE ROLE OF PULSE OXIMETRY - ITS USE AS AN INDICATOR OF SEVERE RESPIRATORY-DISEASE IN PERUVIAN CHILDREN LIVING AT SEA-LEVEL

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 K 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.