Sritippayawan S, Deerojanawong J, Prapphal N
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
J Med Assoc Thai. 2000 Oct;83(10):1215-22.
To determine the correlation between clinical score (based on respiratory rate, chest wall retractions, air entry, wheezing, consciousness and audible wheezing) and arterial oxygen saturation (SaO2: measured by pulse oximetry) as well as the most appropriate total score for predicting hypoxemia (SaO2 < or = 95%) in children diagnosed to have wheezing associated respiratory illness (WARI).
70 children (1 month-5 years old) hospitalized in the Department of Pediatrics, Chulalongkorn Hospital with the diagnosis of WARI from January 1, 1996 to December 31, 1996 were studied. Half of them were diagnosed to have acute lower respiratory tract infection (LRI) with wheezing while the remainder had reactive airway disease (RAD).
Cross sectional, analytical study.
In each group of patients, the clinical score and SaO2 were assessed by the same pediatrician throughout the study. The correlation between the clinical signs and SaO2 as well as the cut off point of total score for predicting hypoxemia were analyzed. The sensitivity, specificity and accuracy of that total score in predicting hypoxemia were also calculated.
In both groups of patients (acute LRI with wheezing and RAD group), the clinical signs correlated with SaO2 were wheezing (rs = -0.67 and -0.47 respectively) and chest wall retractions (rs = -0.57 and -0.59 respectively). Total score was also correlated with SaO2 (rs = -0.68 and -0.5 respectively). The cut off point of total score in predicting hypoxemia was 4 providing 80 per cent sensitivity in both groups with accuracy 74.3 per cent and 80 per cent respectively.
This clinical score may be used to assess the severity of hypoxemia in WARI patients. Wheezing, chest wall retractions and total score correlated well with SaO2. The total score > 4 was most appropriate in predicting hypoxemia in both children with RAD and wheezing associated with LRI.
确定临床评分（基于呼吸频率、胸壁凹陷、呼吸音、喘息、意识及可闻及的喘息声）与动脉血氧饱和度（SaO2：通过脉搏血氧饱和度测定仪测量）之间的相关性，以及预测诊断为喘息相关性呼吸道疾病（WARI）儿童低氧血症（SaO2≤95%）的最合适总分。
对1996年1月1日至1996年12月31日在朱拉隆功医院儿科住院、诊断为WARI的70名儿童（1个月至5岁）进行研究。其中一半被诊断为伴有喘息的急性下呼吸道感染（LRI），其余患有反应性气道疾病（RAD）。
横断面分析研究。
在整个研究过程中，由同一位儿科医生对每组患者的临床评分和SaO2进行评估。分析临床体征与SaO2之间的相关性以及预测低氧血症的总分切点。还计算了该总分预测低氧血症的敏感性、特异性和准确性。
在两组患者（伴有喘息的急性LRI组和RAD组）中，与SaO2相关的临床体征为喘息（rs分别为-0.67和-0.47）和胸壁凹陷（rs分别为-0.57和-0.59）。总分也与SaO2相关（rs分别为-0.68和-0.5）。预测低氧血症的总分切点为4，两组的敏感性均为80%，准确性分别为74.3%和80%。
该临床评分可用于评估WARI患者低氧血症的严重程度。喘息、胸壁凹陷和总分与SaO2相关性良好。总分>4最适合预测RAD患儿以及与LRI相关的喘息患儿的低氧血症。
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