Clinical hypoxemia score for outpatient child pneumonia care lacking pulse oximetry in Africa and South Asia.
Holly B Schuh, Shubhada Hooli, Salahuddin Ahmed, Carina King, Arunangshu D Roy, Norman Lufesi, Asmd Ashraful Islam, Tisungane Mvalo, Nabidul H Chowdhury, Amy Sarah Ginsburg, Tim Colbourn, William Checkley, Abdullah H Baqui, Eric D McCollum
Author Information
Holly B Schuh: Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Shubhada Hooli: Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Salahuddin Ahmed: Projahnmo Research Foundation, Dhaka, Bangladesh.
Carina King: Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Arunangshu D Roy: Projahnmo Research Foundation, Dhaka, Bangladesh.
Norman Lufesi: Malawi Ministry of Health, Lilongwe, Malawi.
Asmd Ashraful Islam: Projahnmo Research Foundation, Dhaka, Bangladesh.
Tisungane Mvalo: University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi.
Nabidul H Chowdhury: Projahnmo Research Foundation, Dhaka, Bangladesh.
Amy Sarah Ginsburg: Clinical Trial Center, University of Washington, Seattle, WA, United States.
Tim Colbourn: Institute for Global Health, University College London, London, United Kingdom.
William Checkley: Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Abdullah H Baqui: Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Eric D McCollum: Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Background: Pulse oximeters are not routinely available in outpatient clinics in low- and middle-income countries. We derived clinical scores to identify hypoxemic child pneumonia. Methods: This was a retrospective pooled analysis of two outpatient datasets of 3-35 month olds with World Health Organization (WHO)-defined pneumonia in Bangladesh and Malawi. We constructed, internally validated, and compared fit & discrimination of four models predicting SpO<���93% and <90%: (1) Integrated Management of Childhood Illness guidelines, (2) WHO-composite guidelines, (3) Independent variable least absolute shrinkage and selection operator (LASSO); (4) Composite variable LASSO. Results: 12,712 observations were included. The independent and composite LASSO models discriminated moderately (both C-statistic 0.77) between children with a SpO<���93% and ���94%; model predictive capacities remained moderate after adjusting for potential overfitting (C-statistic 0.74 and 0.75). The IMCI and WHO-composite models had poorer discrimination (C-statistic 0.56 and 0.68) and identified 20.6% and 56.8% of SpO<���93% cases. The highest score stratum of the independent and composite LASSO models identified 46.7% and 49.0% of SpO<���93% cases. Both LASSO models had similar performance for a SpO<���90%. Conclusions: In the absence of pulse oximeters, both LASSO models better identified outpatient hypoxemic pneumonia cases than the WHO guidelines. Score external validation and implementation are needed.
