Schuh, Holly B;
Hooli, Shubhada;
Ahmed, Salahuddin;
King, Carina;
Roy, Arunangshu D;
Lufesi, Norman;
Islam, ASMD Ashraful;
... McCollum, Eric D; + view all
(2023)
Clinical hypoxemia score for outpatient child pneumonia care lacking pulse oximetry in Africa and South Asia.
Frontiers in Pediatrics
, 11
, Article 1233532. 10.3389/fped.2023.1233532.
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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.
| Type: | Article |
|---|---|
| Title: | Clinical hypoxemia score for outpatient child pneumonia care lacking pulse oximetry in Africa and South Asia |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.3389/fped.2023.1233532 |
| Publisher version: | https://doi.org/10.3389/fped.2023.1233532 |
| Language: | English |
| Additional information: | Copyright © 2023 Schuh, Hooli, Ahmed, King, Roy, Lufesi, Islam, Mvalo, Chowdhury, Ginsburg, Colbourn, Checkley, Baqui and McCollum. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (http://creativecommons.org/licenses/by/4.0/). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
| Keywords: | hypoxia, clinical decision rules, pediatrics, primary health care, low-income countries, respiratory tract infection (RTI) |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10179214 |
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