Background Acute respiratory infection remains a common presentation to Emergency Departments. Oxygen saturations (Sao2) may be useful in determining which febrile infants require chest x-rays (CXR) in investigation for bacterial pneumonia (PNA). This study aimed to determine whether Sao2 is clinically useful in excluding bacterial PNA in febrile infants <24 months.
Methods A febrile infant registry was instituted at a tertiary care military hospital (55 000 annual patients, 27% children) from December 2002–December 2003. Eligible patients consisted of infants <3 months with temperature ≥38°C or 3–24 months with temperature ≥39°C. Bacterial PNA was defined in this cohort by a CXR revealing a ‘lobar infiltrate’ by a board-certified radiologist. Descriptive statistics are presented on groups who received CXR versus groups who did not, and on infants who had bacterial PNA versus those who did not. Student t tests were used to compare maximum temperature (Tmax), RR, and Sao2. Logistic regression for PNA was performed using age, sex, Tmax, RR, HR and Sao2. A Receiver Operator Characteristic (ROC) curve was created to show Sao2 cut-off points as related to sensitivity and specificity.
Results 985 patients (55% boys; median age: 12 months) met entry criteria. 790 underwent CXR and 82 were diagnosed with bacterial PNA. Sao2 was lower in infants with bacterial PNA (96.6%±2.5% vs 97.7%±1.8%, p<0.001). Sao2 was also predictive of bacterial PNA by logistic regression (p=0.017) but the ROC curve yielded a poor sensitivity/specificity profile (area under curve (AUC) of 0.6786).
Conclusions In febrile infants, Sao2 was not found to be clinically useful for excluding bacterial PNA.
- Chest radiograph
- infant, oxygen saturation
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Presented as an abstract at the Society of Academic Emergency Meeting in Chicago, Il in May of 2007.
Funding The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, DC, Clinical Investigations Program, sponsored this report #S-05-75 as required by NSHBETHINST 6000.41B.
Competing interests None.
Ethics approval This study was conducted with the approval of the IRB at Naval Medical Center San Diego.
Provenance and peer review Not commissioned; externally peer reviewed.
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