DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20200676

Applicability of respiratory severity score and modified TAL criteria in pediatric age group for grading and management of acute respiratory illness

Milind B. Kamble, Rajesh Kumar Singh

Abstract


Background: Acute respiratory tract infections (ARI) are the leading cause of death in children in the world (11.9 million per year) with the greatest number of deaths occurring in developing countries like India. We compared respiratory severity scoring system RSS (Respiratory Severity Score) with Modified TAL, so that we can find out which of the above scores are better and whether they can be implemented to assess pediatric ARI patients.

Methods: This prospective observational study was conducted in Pediatrics wards, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra and data were collected from 290 children below 12 years of age by purposive sampling. All the children presenting with respiratory symptoms were subjected to these scoring system (RSS AND MODIFIED TAL) at the time of admission and were classified based on the scores obtained in respective scoring system. Data was analysed using frequencies, percentages and contingency tables and comparison was made between the above scoring systems to find which one is better applicable in pediatric ARI patient.

Results: Incidence of pediatric patients presenting with only respiratory tract infections who are admitted in ward was 25.15 %, with more incidence being reported in children below 12 months (49.31%), males more affected. For both the ARI scoring systems (RSS and MOD TAL) as the severity increased so is the number of patients requiring oxygen and duration of hospitalization increased significantly (p<0.05), with RSS having stronger association.

Conclusions: Both the scoring systems predicted that on admission if the score is more than chances of requirement of oxygen is more and also duration of hospitalization is more, with RSS being better predictor.


Keywords


Applicability, Acute respiratory tract infections, Children, Outcome, Respiratory severity score, TAL

Full Text:

PDF

References


Williams BG, E. Gouws, C. Boschi Pinto, J. Bryce, L. Dye. Estimates of worldwide distribution of child deaths from acute respiratory infections. Lancet Infectious disease. 2002.2:25-32.

Level and trends in child mortality. Report 2014. United Nations Inter Agency Group for child mortality estimation. UNICEF, WHO, The World Bank. United Nations Population Division New York 2014. Available at: https://data.unicef.org/resources/levels-trends-child-mortality-report-2014/. Accessed 20 August 2018.

Global Health Observatory. Proportion of Child deaths cause WHO, Geneva. Available at: http://www.who.int./gho/child_health/en/index.htm. Accessed 15 September 2018.

Ahmad OB, Lopez AD, Inoue M. The decline in child mortality: a repraisal. Bull WHO. 2000;78:1175-91.

Technical bases for the WHO recommendations on the management of pneumonia in children at first-level health facilities. WHO/ARI/91:20. Available at: http://whqlibdoc.who.int/hq/1991/WHO_ARI_91.20pdf. Accessed 15 September 2018.

Revised WHO classification and treatment of pneumonia in children at health facilities: evidence summaries. Integrated Management of Childhood Illness (IMCI). WHO recommendations on the management of diarrhoea and pneumonia in HIV-infected infants and children. Geneva: World Health Organization; 2010. Available at: (http://www.who.int/maternal_child_adolescent/documents/9789241548083/en AND Recommendations for management of common childhood conditions, Evidence for technical update of pocketbook recommendations. Geneva: World Health Organization; 2012.Available at http://www.who.int/maternal_child_adolescent/documents/management_childhood_conditions/en. Accessed 15 September 2018.

Reed C, Madhi SA, Klugman KP, Kuwanda L, Ortiz JR, Finelli L, et al. Development of the Respiratory Index of Severity in Children (RISC) Score among Young Children with Respiratory Infections in South Africa. PLOS ONE. 2012;7(1):e27793.

Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK. Causes of neonatal and child mortality in India: a nationally representative mortality survey, Million Death Study Collaborators. Lancet. 2010;376:1853-60.

Government of India, Health Status Indicators in National Health Profile, 2009, Available at: http://cbhidghs.nic.in/WriteReadData/l892s/File1012.pdf. Accessed 15 September 2018.

WHO, Health Situation in South-East Asia Region 1994-97, Regional office for SEAR, New Delhi, India; 1999. Available at: http://apps.searo.who.int/PDS_DOCS/B4560.pdf. Accessed 15 September 2018.

United Nations Children’s Fund (UNICEF)/World Health Organization (WHO), Pneumonia: the forgotten killer, WHO, New York, NY, USA; 2006. Available at: https://www.who.int/maternal_child_adolescent/documents/9280640489/en/.Accessed 23 September 2018.

World Health Organization and Government of India, Students Handbook for IMNCI: Integrated Management of Neonatal and Childhood Illness, WHO India Country Office, New Delhi, India,2003. Available at: http://www.health.gov.bt/wp-content/uploads/ftps/imnci/IMNCI%20for%20RIHS/IMNCI%20Students% 20 Handbook. pdf Accessed 23 September 2018.

Tal A, Bavilski C, Yohai D, Bearman JE, Gorodischer R, Moses SW. Dexamethasone and salbutamol in the treatment of acute wheezing in infants. Pediatrics. 1983;71:13-8.

Feldman AS, Hartert TV, Gebretsadik T, Carroll KN, Minton PA, Woodward KB, Larkin EK, Miller EK, Valet RS. Respiratory severity score separates upper versus lower respiratory tract infections and predicts measures of disease severity. Pediatr Allergy Immunolo Pulmonol. 2015;28(2):117-20.

Miyaji Y, Sugai K, Nozawa A, Kobayashi M, Niwa S, Tsukagoshi H. Pediatric respiratory severity score (PRESS) for respiratory tract infections in children. Austin Virol Retrovirol. 2015;2(1):1009.

McCallum GB, Morris PS, Wilson CC, Versteegh LA, Ward LM, Chatfield MD, Chang AB. Severity scoring systems: are they internally valid, reliable and predictive of oxygen use in children with acute bronchiolitis?. Pediatr Pulmonol. 2013;48(8):797-803.

Gorelick MH, Stevens MW, Schultz TR, Scribano PV. Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma. Academic emergency medicine. Acad Emerg Med. 2004;11:10-8.

Chalut DS, Ducharme FM, Davis GM. The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity. J Pediatr. 2000;137:762-8.

Arnold DH, Gebretsadik T, Abramo TJ, Moons KG, Sheller JR, Hartert TV. The RAD score: a simple acute asthma severity score compares favorably to more complex scores. Ann Allergy Asthma Immunol. 2011;107:22-8.

Fujitsuka A. Lower respiratory infection with respiratory virus associates to bronchial asthma in children. Allerugie. 2011;60:1393.

Golan‐Tripto I, Goldbart A, Akel K, Dizitzer Y, Novack V, Tal A. Modified Tal Score: Validated score for prediction of bronchiolitis severity. Pediatr Pulmonol. 2018;53(6):796-801.