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Published on: December 5, 2025

Admission Respiratory Rate-Oxygenation Index and Outcome of Acute Respiratory Illness in a Pediatric Intensive Care

Vijendra Singh1, Umesh Pandwar1, Navindana1

  • 1Paediatrics, Gandhi Medical College, Bhopal, Bhopal, IND.

Cureus
|July 28, 2026
PubMed

Insights

The Respiratory Rate-Oxygenation (ROX) Index effectively predicts mortality and the need for ventilation in children with acute respiratory illness. Lower ROX index values indicate higher risk, aiding early recognition in pediatric intensive care units.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Clinical Diagnostics

Background:

  • Acute respiratory illness (ARI) is a major cause of mortality in pediatric intensive care units (PICUs) in low- and middle-income countries.
  • Early identification of children at risk of deterioration or requiring ventilatory support is crucial for improving outcomes.
  • The Respiratory Rate-Oxygenation (ROX) Index is a validated non-invasive tool for adults but lacks pediatric evidence.

Purpose of the Study:

  • To evaluate the association between the admission ROX Index and mortality in pediatric ARI patients.
  • To assess the correlation of the admission ROX Index with the requirement for positive-pressure ventilation (PPV) in these children.

Main Methods:

  • A prospective observational study included 200 children aged two months to five years with ARI admitted to a tertiary-care PICU.
  • The ROX Index was calculated at admission using peripheral oxygen saturation (SpO₂), fraction of inspired oxygen (FiO₂), and respiratory rate.
  • Primary outcomes included in-hospital mortality and the need for PPV; data were analyzed using non-parametric tests and ROC analysis.

Main Results:

  • Overall mortality was 7%. Non-survivors had a significantly lower median admission ROX Index (5.6) compared to survivors (6.3; p=0.002).
  • The ROX Index demonstrated moderate discrimination for mortality (AUC=0.746) with an optimal cut-off ≤6.4.
  • Discrimination for predicting PPV requirement was good (AUC=0.867) with an optimal cut-off ≤6.2, identifying 88% of cases needing PPV.

Conclusions:

  • The admission ROX Index is a simple, non-invasive, and reliable predictor of mortality and ventilatory support needs in pediatric ARI.
  • An admission ROX Index cut-off of ≤6.2 accurately identifies high-risk children requiring closer monitoring and potential intervention.
  • Integrating the ROX Index into triage protocols can enhance early recognition and management of severe pediatric ARI in resource-limited settings.

Keywords:
acute respiratory illnessmortality predictorpediatric intensive carepositive pressure ventilationrespiratory rate-oxygenative indexrox index

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