© 1993 Oxford University Press
other |
Caretaker Recognition of Respiratory Signs in Children: Correlation with Physical Examination Findings, X-ray Diagnosis and Pulse Oximetry
* Department of International Health, School of Hygiene and Public Health Baltimore, Maryland, USA
** Universities of Alexandria Egypt
Assiut Egypt
Ismailia Egypt
§ Al Azhar Egypt
| ARI Control Program, Child Survival Project Cairo, Egypt
Reprint requests to: Dr A M Gadomski, Department of Pediatrics, University of Maryland, 700 West Lombard St.Baltimore, MD 2120l, USA
Caretaker recognition and clinical utility of respiratory signs and symptoms in the prediction of pneumonia was examined in a prospective study of infants and children in four cities in Egypt. In all 688 children aged 2 months-5 years presenting with a history and/or physical examination findings of cough and difficult or fast breathing were recruited from outpatient health facilities. The validity of caretaker terms was determined using paediatrician observation of standard respiratory signs and symptoms, x-ray diagnosis and pulse oximetry as standards. The sensitivity of ‘nahagan’ (Egyptian Arabic for fast breathing) for identifying elevated respiratory rate was 78% ± 4, and was slightly higher for <12 month olds (85% ± 5) versus children aged 1–5 years (74% ± 5). ‘Sedro tale nazel’, which describes the chest as moving up and down, was a sensitive (86% ± 3) and specific (60% ± 4) indicator of chest indrawing. ‘Tazyeek’ (wheeze) had a sensitivity of 75% ± 3 and specificity of 66% ± 4 when compared to paediatrician assessment of wheezing during physical examination. Although not specific, the caretaker terms, ‘nahagan’ or ‘nafas seria’ (fast breathing) and ‘sedro tale nazel’ (chest indrawing), either spontaneously or after asking, were sensitive (>71%) indicators of radiologic pneumonia and oxygen desaturation, and therefore can be used to prompt timely health seeking behaviour in these settings.
Received 1 May 1993