The pathognomonic value of symptoms and signa in the management of acute respiratory infections in young children

ABSTRACT

1826 children attending the out patient department of Mandalay General Hospital, from 1st February 1986 to 31st January 1987 with acute respiratory infection (ARI) related symptoms were classified by the primafry health workers as mild, moderate and severe ARI cases (i.e. initial classification). These children were again examined by the investigator (doctor) and appropriate treatment was given. The cases were followed up till they died or were well. The final classification was done considering the clinical presentation, response to the treatment and the outcome of the patient. To deteremine the pathognomonic value of clinical signs and symptoms in classification of severity of ARI cases, different criteria for classification of severe ARI were laid down, the ilnitial and final classification were compared and their respective sensitivity and specificity were calculated. It is concluded that out of the clinical signs and symptoms of respiratory distress, tachypnoea, chest indrawing and inability to drink were found to be important clinical signs and sylmptoms in determination of the severity of ARI. In addition to the criteria proposed by the WHO, very fast breathing (i.e respiratory rate over 70/min) with or without wheeze should be one of the criteria in classification of servere ARI.