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• W2616016807 abstract "Introduction Recognizing and correcting poor oxygenation early is an essential aspect of paediatric emergency care. The management of hypoxaemia includes establishing an open airway and alveolar ventilatjon, providing supplemental oxygen, restoring circulation and treating the underlying cause. Hypoxaemia correlates with mortality, (1) and early assessment and prompt oxygen therapy probably improve survival. (2,3) In developing countries, bottled oxygen is expensive and commonly in short supply. However, most hospitals providing secondary care cannot perform pulse oximetry or measure arterial oxygen concentration to properly target oxygen delivery. Furthermore, clinical assessment is often carried out by relatively inexperienced health workers, as a result of which simple algorithms for identifying hypoxaemia have been developed and studied. However, the studies have been conducted almost entirely among children with lower respiratory tract infection (LRTI), (4-9) and little prospective vaiidation has been performed. Certain clinical signs have been identified as predictive of hypoxaemia: a fast respiratory rate for age, lower chest wall indrawing, grunting, head nodding, cyanosis, the absence of crying during the examination, and the inability to breastfeed or drink. No single sign is a reliable predictor, and sensitivity is generaily low for any single sign. (10) WHO currently recommends giving oxygen urgently to children with cyanosis, signs of shock, severe respiratory distress, the of very severe or a respiratory rate of 70 breaths per minute (min) or more. (11) Given the paucity of data outside the context of LRTI, we first aimed to describe the prevalence of hypoxaemia in relation to the WHO clinical syndromes of pneumonia at admission and the final diagnoses made at discharge. We then tested the hypothesis that hypoxaemia could be identified on the basis of clinical signs by studying a large population of children consecutively admitted to a rural, Kenyan district hospital, irrespective of their diagnosis. We report findings from 15 289 children and neonates admitted during a 3-year period and validate our findings using data from 4695 admissions over a fourth year. Methods Study setting Since 1998 we have Conducted continuous inpatient surveillance to describe the causes and clinical features of common illnesses among children admitted to Kilifi District Hospital in Kenya. (12,13) The hospital is located at sea level in an area with endemic malaria. Government-employed clinical officers not involved in research refer children to the paediatric ward (40 beds) or the high-dependency unit (6 beds). On admission, discharge or death, standardized clinical and laboratory data are collected by clinical officers, who in Kenya receive 3 years of basic medical training, or by fully trained medical officers with less than 5 years of paediatric experience. (12,13) For this analysis, we used data collected at admission from January 2002 to December 2005 and final discharge diagnosis for each consecutive admission over the same period of time. The Kenyan National Scientific and Ethical Review Boards and the Coventry Research Ethics Committee approved the study. Clinical definitions WHO defines a set of clinical syndromes of pneumonia on the basis of clinical history and clinical signs at presentation for the purpose of determining the need for admission and the type of antibiotic treatment required. (11,14) The definitions have high sensitivity with respect to LRTI, but they lack specificity. The syndrome of is defined as a history of cough or difficulty breathing plus an elevated respiratory rate for age (if" @default.
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• W2616016807 date "2009-04-01" @default.
• W2616016807 modified "2023-09-27" @default.
• W2616016807 title "Emergency Triage Assessment for Hypoxaemia in Neonates and Young Children in a Kenyan Hospital: An Observational study/Evaluation Dans le Cadre Du Triage D'urgence Des Cas D'hypoxemie Parmi Les Nouveau-Nes et Les Jeunes Enfants Dans Un Hopital Kenyan: Etude d'observation/Triaje De Emergencia De la Hipoxemia En Neonatos Y Ninos De Corta Edad En Un Hospital De Kenya: Estudio Observacional" @default.
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