■低收入国家的5岁以下肺炎死亡率仍然很高。2014年,世界卫生组织(WHO)建议儿童胸部拉伤肺炎,但在社区中没有危险迹象或外周血氧饱和度(SpO2)<90%的情况下,而不是住院。在马拉维,脉搏血氧饱和度的可用性有限。
■马拉维13,413例5岁以下肺炎病例的二次分析。根据2005年和2014年世卫组织儿童疾病综合管理(IMCI)指南的假设,按疾病严重程度计算肺炎相关病死率(CFR)。有和没有脉搏血氧饱和度。我们调查了脉搏血氧饱和度读数是否不随机丢失(MNAR)。
■根据2014年IMCI指南,在没有脉搏血氧饱和度的假设下,被归类为非重症肺炎的患者的CFR增加了一倍(1.5%没有脉搏血氧饱和度,0.7%没有脉搏血氧饱和度,P<0.001)。当2014年IMCI指南应用脉搏血氧饱和度和SpO2<90%作为转诊和/或入院的阈值时,符合住院标准的病例数减少了70.3%。未记录的脉搏血氧饱和度读数为MNAR,调整后的死亡率为4.9(3.8,6.3),类似于SpO2<90%的情况。虽然住院的女孩较少,女性是独立的死亡危险因素.
■在马拉维,实施2014年世卫组织IMCI肺炎指南,没有脉搏血氧饱和度,会错过高风险病例。或者,如果无法获得脉搏血氧饱和度读数被认为是WHO的危险信号,则实施脉搏血氧饱和度可能导致住院率大幅降低,而不会显著增加非重症肺炎相关CFR.
UNASSIGNED: Under-5 pneumonia mortality remains high in low-income countries. In 2014 the World Health Organization (WHO) advised that children with chest indrawing pneumonia, but without danger signs or peripheral oxygen saturation (SpO 2) < 90% be treated in the community, rather than hospitalized. In Malawi there is limited pulse oximetry availability.
UNASSIGNED: Secondary analysis of 13,413 under-5 pneumonia cases in Malawi. Pneumonia associated case fatality ratios (CFR) were calculated by disease severity under the assumptions of the 2005 and 2014 WHO Integrated Management of Childhood Illness (IMCI)
guidelines, with and without pulse oximetry. We investigated if pulse oximetry readings were missing not at random (MNAR).
UNASSIGNED: The CFR of patients classified as having non-severe pneumonia per the 2014 IMCI
guidelines doubled under the assumption that pulse oximetry was not available (1.5% without pulse oximetry vs 0.7% with pulse oximetry, P<0.001). When 2014 IMCI
guidelines were applied with pulse oximetry and a SpO 2 < 90% as the threshold for referral and/or admission, the number of cases meeting hospitalization criteria decreased by 70.3%. Unrecorded pulse oximetry readings were MNAR with an adjusted odds for mortality of 4.9 (3.8, 6.3), similar to that of a SpO 2 < 90%. Although fewer girls were hospitalized, female sex was an independent mortality risk factor.
UNASSIGNED: In Malawi, implementation of the 2014 WHO IMCI pneumonia
guidelines, without pulse oximetry, will miss high risk cases. Alternatively, implementation of pulse oximetry may result in a large reduction in hospitalization rates without significantly increasing non-severe pneumonia associated CFR if the inability to obtain a pulse oximetry reading is considered a WHO danger sign.