A comparative study of clinical signs versus pulse oximetry for prediction of hypoxia in very severe pneumonia in children

Background: Severe pneumonia is a leading cause of pediatric mortality, especially in developing countries. Hypoxia, a common complication, requires accurate and timely detection. Traditional clinical signs and the more recent pulse oximetry are both used to predict hypoxia, but their comparative effectiveness in very severe pneumonia is not well-established. Methods: This cross-sectional observational study was conducted at SPMCHI Hospital, SMS Medical College, Jaipur, from September 2019 to May 2020. It involved 150 children aged 2 months to 5 years, diagnosed with very severe pneumonia per F-IMNCI guidelines. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of clinical signs versus pulse oximetry in predicting hypoxia. Results: Of the 150 children, 67.3% were aged 2–12 months. Hypoxia was more prevalent in this age group (58.4%) compared to children older than 12 months (40.8%) (p=0.042). Gender did not significantly affect hypoxia incidence. Pulse oximetry showed higher specificity and sensitivity compared to clinical signs alone, with respiratory rates ≥70/min providing the highest specificity (92.6%). Conclusions: Pulse oximetry provides a more reliable diagnostic tool for predicting hypoxia in children with very severe pneumonia compared to traditional clinical signs, suggesting a need for broader implementation in resource-limited settings.