RESUMEN
OBJECTIVES: To evaluate the diagnostic accuracy of the clinical examination in detecting hypoxemia in infants with lower respiratory tract illness. DESIGN: Cross-sectional study. SETTING: Three university pediatric outpatient departments and one private pediatric practice. PATIENTS: Healthy infants less than 1 year of age seen between December and March 1989 and 1990, with symptoms suggesting acute lower respiratory tract illness. MAIN OUTCOME MEASURES: The test characteristics of 27 elements of the clinical examination, as well as the accuracy of the overall examination and the components of the examination in detecting oxygen saturation < 95% measured by pulse oximetry. Reliability of clinical examination findings. RESULTS: None of the 27 clinical findings had sensitivities that would make them useful diagnostic tests for hypoxemia. By combining all the clinical findings, however, we found good diagnostic accuracy (area under the receiver operator characteristic curve 0.90). Three groups of clinical findings--social interactiveness, respiratory effort, and physical appearance--accounted for much of the diagnostic accuracy of the examination. Auscultatory findings contributed little. In these three groups, five clinical findings accounted for almost all the accuracy: attentiveness, consolability, respiratory effort, color, and movement. Together, these findings also had good accuracy (area under the receiver operator characteristic curve 0.95). CONCLUSIONS: A small number of clinical observations may be mostly responsible for the diagnostic value of the clinical examination of infants with symptoms of LRI. Concentrating on a limited group of findings appears to enhance the accuracy of the examination in detecting hypoxemia.
Asunto(s)
Hipoxia/diagnóstico , Infecciones del Sistema Respiratorio/complicaciones , Estudios Transversales , Femenino , Humanos , Hipoxia/etiología , Lactante , Masculino , Variaciones Dependientes del Observador , Oxígeno/sangre , Examen Físico , Reproducibilidad de los Resultados , Infecciones del Sistema Respiratorio/sangre , Sensibilidad y EspecificidadRESUMEN
The overall purpose of this study was to describe the developmental and functional status of young Latino children. We analyzed data from the Hispanic Health and Nutrition Examination Survey and estimated the percentages of young Mexican-American and mainland Puerto Rican children with indicators of developmental need for special services, i.e., low birth weight, use of neonatal intensive care, congenital problems, chronic conditions of developmental concern, functional limitations, and physician diagnoses of medical conditions. Estimates suggest that Puerto Rican children had substantially poorer status than Mexican-American children who, in turn, have indicators that are comparable with those reported for the general population. The difference in status between the two Latino groups merits further investigation.