Respiratory rate and pulse oximetry derived information as predictors of hospital admission in young children in Bangladesh: a prospective observational study.
BMJ Open
; 6(8): e011094, 2016 08 17.
Article
en En
| MEDLINE
| ID: mdl-27534987
ABSTRACT
OBJECTIVE:
Hypoxaemia is a strong predictor of mortality in children. Early detection of deteriorating condition is vital to timely intervention. We hypothesise that measures of pulse oximetry dynamics may identify children requiring hospitalisation. Our aim was to develop a predictive tool using only objective data derived from pulse oximetry and observed respiratory rate to identify children at increased risk of hospital admission.SETTING:
Tertiary-level hospital emergency department in Bangladesh.PARTICIPANTS:
Children under 5â years (n=3374) presenting at the facility (October 2012-April 2013) without documented chronic diseases were recruited. 1-minute segments of pulse oximetry (photoplethysmogram (PPG), blood oxygen saturation (SpO2) and heart rate (HR)) and respiratory rate were collected with a mobile app. PRIMARYOUTCOME:
The need for hospitalisation based on expert physician review and follow-up.METHODS:
Pulse rate variability (PRV) using pulse peak intervals of the PPG signal and features extracted from the SpO2 signal, all derived from pulse oximetry recordings, were studied. A univariate age-adjusted logistic regression was applied to evaluate differences between admitted and non-admitted children. A multivariate logistic regression model was developed using a stepwise selection of predictors and was internally validated using bootstrapping.RESULTS:
Children admitted to hospital showed significantly (p<0.01) decreased PRV and higher SpO2 variability compared to non-admitted children. The strongest predictors of hospitalisation were reduced PRV-power in the low frequency band (OR associated with a 0.01â unit increase, 0.93; 95% CI 0.89 to 0.98), greater time spent below an SpO2 of 98% and 94% (OR associated with 10â s increase, 1.4; 95% CI 1.3 to 1.4 and 1.5; 95% CI 1.4 to 1.6, respectively), high respiratory rate, high HR, low SpO2, young age and male sex. These variables provided a bootstrap-corrected AUC of the receiver operating characteristic of 0.76.CONCLUSIONS:
Objective measurements, easily obtained using a mobile device in low-resource settings, can predict the need for hospitalisation. External validation will be required before clinical adoption.Palabras clave
Texto completo:
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Base de datos:
MEDLINE
Asunto principal:
Frecuencia Respiratoria
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
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Risk_factors_studies
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Screening_studies
País/Región como asunto:
Asia
Idioma:
En
Revista:
BMJ Open
Año:
2016
Tipo del documento:
Article