PMID- 30986206
OWN - NLM
STAT- MEDLINE
DCOM- 20191231
LR  - 20200309
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 14
IP  - 4
DP  - 2019
TI  - Retrospective study on the usefulness of pulse oximetry for the identification of 
      young children with severe illnesses and severe pneumonia in a rural outpatient 
      clinic of Papua New Guinea.
PG  - e0213937
LID - 10.1371/journal.pone.0213937 [doi]
LID - e0213937
AB  - OBJECTIVE: This secondary analysis of data of a randomized controlled trial (RCT) 
      retrospectively investigated the performance of pulse oximetry in identifying 
      children with severe illnesses, with and without respiratory signs/symptoms, in a 
      cohort of children followed for morbid episodes in an intervention trial 
      assessing the efficacy of Intermittent Preventive Treatment for malaria in 
      infants (IPTi) in Papua New Guinea (PNG) from June 2006 to May 2010. SETTING: The 
      IPTi study was conducted in a paediatric population visiting two health centres 
      on the north coast of PNG in the Mugil area of the Sumkar District. PARTICIPANTS: 
      A total of 669 children visited the clinic and a total of 1921 illness episodes 
      were recorded. Inclusion criteria were: age between 3 and 27 months, full 
      clinical record (signs/symptoms) and pulse oximetry used systematically to assess 
      sick children at all visits. Children were excluded if they visited the clinic in 
      the previous 14 days. OUTCOMES: The outcome measures were severe illness, severe 
      pneumonia, pneumonia, defined by the Integrated Management of Childhood Illness 
      (IMCI) definitions, and hospitalization. RESULTS: Out of 1921 illness episodes, 
      1663 fulfilled the inclusion criteria. A total of 139 severe illnesses were 
      identified, of which 93 were severe pneumonia. The ROC curves of pulse oximetry 
      (continuous variable) showed an AUC of 0.63, 0.68 and 0.65 for prediction of 
      severe illness, severe pneumonia and hospitalization, respectively. Pulse 
      oximetry allowed better discrimination between severe and non-severe illness, 
      severe and non-severe pneumonia, admitted and non-admitted patients, in children 
      </=12-months of age relative to older patients. For the threshold of peripheral 
      arterial oxygen saturation </= 94% measured by pulse oximetry (SpO2), unadjusted 
      odds ratios for severe illness, severe pneumonia and hospitalization were 6.1 
      (95% Confidence Interval (CI) 3.9-9.8), 8.5 (4.9-14.6) and 5.9 (3.4-10.3), 
      respectively. CONCLUSION: Pulse oximetry was helpful in identifying children with 
      severe illness in outpatient facilities in PNG. A SpO2 of 94% seems the most 
      discriminative threshold. Considering its affordability and ease of use, pulse 
      oximetry could be a valuable additional tool assisting the decision to admit for 
      treatment.
FAU - Blanc, Julien
AU  - Blanc J
AUID- ORCID: 0000-0001-7537-2763
AD  - Department of Ambulatory Care and Community Medicine, University of Lausanne, 
      Lausanne, Switzerland.
FAU - Locatelli, Isabella
AU  - Locatelli I
AD  - Department of Ambulatory Care and Community Medicine, University of Lausanne, 
      Lausanne, Switzerland.
FAU - Rarau, Patricia
AU  - Rarau P
AD  - Vector Borne Disease Unit, PNG Institute of Medical Research, Madang (MAD), Papua 
      New Guinea.
FAU - Mueller, Ivo
AU  - Mueller I
AD  - Vector Borne Disease Unit, PNG Institute of Medical Research, Madang (MAD), Papua 
      New Guinea.
AD  - Population Health & Immunity Division, Walter & Eliza Hall Institute of Medical 
      Research, Melbourne, Australia.
AD  - Barcelona Institute of Global Health (ISGLOBAL), Barcelona, Spain.
AD  - Malaria, Parasites & Hosts Unit, Institut Pasteur, Paris, France.
FAU - Genton, Blaise
AU  - Genton B
AD  - Department of Ambulatory Care and Community Medicine, University of Lausanne, 
      Lausanne, Switzerland.
AD  - Infectious Diseases Service, University Hospital, Lausanne, Switzerland.
AD  - Swiss Tropical and Public Health Institute, University of Lausanne, Switzerland.
FAU - Boillat-Blanco, Noemie
AU  - Boillat-Blanco N
AD  - Department of Ambulatory Care and Community Medicine, University of Lausanne, 
      Lausanne, Switzerland.
AD  - Infectious Diseases Service, University Hospital, Lausanne, Switzerland.
FAU - Gehri, Mario
AU  - Gehri M
AD  - Children's Hospital, Lausanne, Switzerland.
FAU - Senn, Nicolas
AU  - Senn N
AD  - Department of Ambulatory Care and Community Medicine, University of Lausanne, 
      Lausanne, Switzerland.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20190415
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Ambulatory Care/methods/organization & administration
MH  - Child, Preschool
MH  - Community Health Centers/*organization & administration
MH  - Feasibility Studies
MH  - Female
MH  - Health Plan Implementation/organization & administration
MH  - Humans
MH  - Hypoxia/*diagnosis/etiology
MH  - Infant
MH  - Male
MH  - *Oximetry
MH  - Papua New Guinea
MH  - Pneumonia/complications/*diagnosis
MH  - Randomized Controlled Trials as Topic
MH  - Retrospective Studies
MH  - Rural Health Services/*organization & administration
MH  - Severity of Illness Index
PMC - PMC6464326
COIS- The authors declared that no competing interests exist.
EDAT- 2019/04/16 06:00
MHDA- 2020/01/01 06:00
PMCR- 2019/04/15
CRDT- 2019/04/16 06:00
PHST- 2018/12/16 00:00 [received]
PHST- 2019/03/04 00:00 [accepted]
PHST- 2019/04/16 06:00 [entrez]
PHST- 2019/04/16 06:00 [pubmed]
PHST- 2020/01/01 06:00 [medline]
PHST- 2019/04/15 00:00 [pmc-release]
AID - PONE-D-18-35884 [pii]
AID - 10.1371/journal.pone.0213937 [doi]
PST - epublish
SO  - PLoS One. 2019 Apr 15;14(4):e0213937. doi: 10.1371/journal.pone.0213937. 
      eCollection 2019.