Accuracy of symptoms and signs in predicting hypoxaemia among young children with acute respiratory infection: a meta-analysis [Review article]
METHODS: We conducted a systematic review and meta-analysis of prospective diagnostic studies that evaluated the accuracy of individual or combined clinical symptoms and signs in predicting hypoxaemia among children aged <5 years with ARI. MEDLINE® was searched for articles published between 1950 and March 2010. Measurement of arterial haemoglobin oxygen saturation by pulse oximetry was used as reference standard. The hierarchical summary receiver operating characteristic model for meta-analyses was applied.
RESULTS: Eleven diagnostic studies with 5787 patients were included in the review. There was substantial variation in sensitivity and specificity between different symptoms and signs as well as across studies. Cyanosis, inability to feed, head nodding, respiratory rate > 70/min and unresponsiveness/impaired rousability had high specificity but low sensitivity. In contrast, reported rapid breathing and crepitations in lung auscultation had relatively high sensitivity but low specificity. Five models of a combination of symptoms and signs presented moderate sensitivity (range 0.60–0.84) and specificity (range 0.63–0.82).
CONCLUSIONS: Neither single nor combined symptoms and signs have satisfactory performance in predicting hypoxaemia among young children with ARI. Improved access to pulse oximetry is needed in developing countries.
Document Type: Review Article
Affiliations: 1: Maternal and Child Health Unit, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil 2: Population & Health Unit, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil 3: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
Publication date: 2011-03-01
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website
- Editorial Board
- Information for Authors
- Subscribe to this Title
- International Journal of Tuberculosis and Lung Disease
- Public Health Action
- Ingenta Connect is not responsible for the content or availability of external websites