Clinical Score and Arterial Oxygen Saturation in Children with Wheezing Associated Respiratory Illness (WARI)
SUCHADA SRITIPPAYAWAN,M.D.*, JITLADDA DEEROJANA WONG, M.D.*, NUANCHAN PRAPPHAL, M.D.*
Affiliation : *Department of Pediatrics, Faculty of Medicine, Chulalongkom University, Bangkok 10330, Thailand.
Objectives : To detennine the correlation between clinical score (based on respiratory
rate, chest wall retractions, air entry, wheezing, consciousness and audible wheezing) and arterial
oxygen saturation (Sa02 : measured by pulse oximetry) as well as the most appropriate total score
for predicting hypoxemia (Sa02 ~ 95%) in children diagnosed to have wheezing associated res-
piratory illness (W ARI).
Subjects : 70 children ( 1 month - 5 years old) hospitalized in the Department of
Pediatrics, Chulalongkorn Hospital with the diagnosis of W ARI from January I, 1996 to Decem-
ber 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).
Design : Cross sectional, analytical study
Method : In each group of patients, the clinical score and Sa02 were assessed by the
same pediatrician throughout the study. The correlation between the clinical
signs and Sa02 as
well as the cut off point of total score for predicting hypoxemia were analyzed. The ~ensitivity,
specificity and accuracy of that total score in predicting hypoxemia were also calculated.
Result : In both groups of patients (acute LRI with wheezing and RAD group), the
clinical signs correlated with Sa02 were wheezing (r, = -0.67 and -0.47 respectively) and chest wall
retractions (r = -0.57 and -0.59 respectively).Total score was also correlated with SaO, (r =
-0.68 and -0.'5 respectively). The cut off point of total score in predicting hypoxemia was -4 p~o
viding 80 per cent sensitivity in both groups with accuracy 74.3 per cent and 80 per cent res-
pectively.
Conclusion : 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 SaO,. The
total score > 4 was most appropriate in predicting hypoxemia in both children with RAD and
wheezing associated with LRI.
Keywords : Clinical Score, Arterial Oxygen Saturation, W ARI, Children
