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. 2023 Oct 4:11:1233532.
doi: 10.3389/fped.2023.1233532. eCollection 2023.

Clinical hypoxemia score for outpatient child pneumonia care lacking pulse oximetry in Africa and South Asia

Holly B Schuh #  1   2 , Shubhada Hooli #  1   3 , Salahuddin Ahmed  4 , Carina King  5 , Arunangshu D Roy  4 , Norman Lufesi  6 , Asmd Ashraful Islam  4 , Tisungane Mvalo  7   8 , Nabidul H Chowdhury  4 , Amy Sarah Ginsburg  9 , Tim Colbourn  10 , William Checkley  11   12 , Abdullah H Baqui  13 , Eric D McCollum  1   13
Affiliations

Clinical hypoxemia score for outpatient child pneumonia care lacking pulse oximetry in Africa and South Asia

Holly B Schuh et al. Front Pediatr. .

Abstract

Background: Pulse oximeters are not routinely available in outpatient clinics in low- and middle-income countries. We derived clinical scores to identify hypoxemic child pneumonia.

Methods: This was a retrospective pooled analysis of two outpatient datasets of 3-35 month olds with World Health Organization (WHO)-defined pneumonia in Bangladesh and Malawi. We constructed, internally validated, and compared fit & discrimination of four models predicting SpO2 < 93% and <90%: (1) Integrated Management of Childhood Illness guidelines, (2) WHO-composite guidelines, (3) Independent variable least absolute shrinkage and selection operator (LASSO); (4) Composite variable LASSO.

Results: 12,712 observations were included. The independent and composite LASSO models discriminated moderately (both C-statistic 0.77) between children with a SpO2 < 93% and ≥94%; model predictive capacities remained moderate after adjusting for potential overfitting (C-statistic 0.74 and 0.75). The IMCI and WHO-composite models had poorer discrimination (C-statistic 0.56 and 0.68) and identified 20.6% and 56.8% of SpO2 < 93% cases. The highest score stratum of the independent and composite LASSO models identified 46.7% and 49.0% of SpO2 < 93% cases. Both LASSO models had similar performance for a SpO2 < 90%.

Conclusions: In the absence of pulse oximeters, both LASSO models better identified outpatient hypoxemic pneumonia cases than the WHO guidelines. Score external validation and implementation are needed.

Keywords: clinical decision rules; hypoxia; low-income countries; pediatrics; primary health care; respiratory tract infection (RTI).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Comparison of ROC curves for identifying SpO2 < 93% cases (validation dataset). ROC, receiver operating characteristic curve; SpO2, peripheral arterial oxyhemoglobin saturation; IMCI, integrated management of childhood illnesses; WHO, World Health Organization; LASSO, least absolute shrinkage and selection operator reduction method.
See this image and copyright information in PMC

References

    1. GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet Infect Dis. (2018) 18(11):1191–210. 10.1016/S1473-3099(18)30310-4 - DOI - PMC - PubMed
    1. Ginsburg AS, Van Cleve WC, Thompson MIW, English M. Oxygen and pulse oximetry in childhood pneumonia: a survey of healthcare providers in resource-limited settings. J Trop Pediatr. (2012) 58(5):389–93. 10.1093/tropej/fmr103 - DOI - PubMed
    1. Lazzerini M, Sonego M, Pellegrin MC. Hypoxaemia as a mortality risk factor in acute lower respiratory infections in children in low and middle-income countries: systematic review and meta-analysis. PLoS One. (2015) 10(9):e0136166. 10.1371/journal.pone.0136166 - DOI - PMC - PubMed
    1. McCollum ED, King C, Colbourn T, Graham H, Bernstein M, Wilson IH, et al. Pulse oximetry in paediatric primary care in low-income and middle-income countries. Lancet Respir Med. (2019) 7(12):1001–2. 10.1016/S2213-2600(19)30358-3 - DOI - PMC - PubMed
    1. World Health Organization. Integrated management of childhood illness (IMCI): Chart booklet. 2nd ed Geneva, Switzerland: WHO Press; (2014). 80.

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