Comparison Of Mortality Risk Scores Among Under-Five Children With Community Acquired Pneumonia At The National Institute Of Child Health Between The Years 2013 - 2015, Lima, Peru

Abstract

Objective: Establish which scale has better performance as a predictor of death due to community-acquired pneumonia (CAP) in children under five years of age at the National Institute of Child Health (INSN). Methods: Observational, retrospective, analytical type study with diagnostic precision type design in a cohort in the INSN between 2013 and 2015. The clinical records of patients with CAP in the first 24 hours of admission to the hospital will be analyzed in the period to be evaluated. The performance of the three scales will be evaluated by the area under the ROC curve (receiver operating characteristics) as a measure of discriminative capacity. Results: The PIRO modified scale (Predisposition, Insult, Response and Organic dysfunction) has greater discrimination capacity with an area under the curve of 0.93 (95% CI 0.89 - 0.96) being the best of the three evaluated. Secondly, the RISC scale (Respiratory Severity Index in children) with 0.83 (95% CI: 0.79-0.87) and, finally, the PRESS scale (Pediatric Respiratory Severity Score) 0.67 (95% CI 0.61 - 0.74). Conclusion: The PIROm and RISC scales are good predictors of NAC mortality in children from 29 days to 59 months, based on clinical, radiological and laboratory criteria. The first could be used in healthcare centers of higher complexity. The second scale purely clinical could be used in centers of primary health care attention. It is suggested to carry out more studies in diverse populations of Perú.