Role of Clinical Criteria and Oxygen Saturation Monitoring in Diagnosis of Childhood Pneumonia in Children Aged 2 to 59 Months.

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.