Respiratory rate and pulse oximetry derived information as predictors of hospital admission in young children in Bangladesh: A prospective observational study

Ainara Garde, Guohai Zhou, Shahreen Raihana, Dustin Dunsmuir, Walter Karlen, Parastoo Dekhordi, Tanvir Huda, Shams El Arifeen, Charles Larson, Niranjan Kissoon, Guy A. Dumont, John Mark Ansermino

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OBJECTIVE Hypoxaemia is a strong predictor of mortality in children. Early detection of deteriorating condition is vital to timely intervention. We hypothesise that measures of pulse oximetry dynamics may identify children requiring hospitalisation. Our aim was to develop a predictive tool using only objective data derived from pulse oximetry and observed respiratory rate to identify children at increased risk of hospital admission.

SETTING Tertiary-level hospital emergency department in Bangladesh.

PARTICIPANTS Children under 5 years (n=3374) presenting at the facility (October 2012-April 2013) without documented chronic diseases were recruited. 1-minute segments of pulse oximetry (photoplethysmogram (PPG), blood oxygen saturation (SpO2) and heart rate (HR)) and respiratory rate were collected with a mobile app.

PRIMARY OUTCOME The need for hospitalisation based on expert physician review and follow-up.

METHODS Pulse rate variability (PRV) using pulse peak intervals of the PPG signal and features extracted from the SpO2 signal, all derived from pulse oximetry recordings, were studied. A univariate age-adjusted logistic regression was applied to evaluate differences between admitted and non-admitted children. A multivariate logistic regression model was developed using a stepwise selection of predictors and was internally validated using bootstrapping.

RESULTS Children admitted to hospital showed significantly (p<0.01) decreased PRV and higher SpO2 variability compared to non-admitted children. The strongest predictors of hospitalisation were reduced PRV-power in the low frequency band (OR associated with a 0.01 unit increase, 0.93; 95% CI 0.89 to 0.98), greater time spent below an SpO2 of 98% and 94% (OR associated with 10 s increase, 1.4; 95% CI 1.3 to 1.4 and 1.5; 95% CI 1.4 to 1.6, respectively), high respiratory rate, high HR, low SpO2, young age and male sex. These variables provided a bootstrap-corrected AUC of the receiver operating characteristic of 0.76.

CONCLUSIONS Objective measurements, easily obtained using a mobile device in low-resource settings, can predict the need for hospitalisation. External validation will be required before clinical adoption.

Original languageEnglish
Article numbere011094
JournalBMJ open
Issue number8
Publication statusPublished - 1 Aug 2016
Externally publishedYes


  • Global health
  • Heart rate variability
  • Mobile health
  • Paediatric infectious disease
  • Pulse oximetry


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