Abstract
Objective
In the perspective of integrated management of childhood illness (IMCI) strategy and recent evidence favoring use of oral antibiotics in severe pneumonia, a generic illness severity index — Acute Illness Observation Scale (AIOS)-was prospectively validated in children with severe pneumonia in a civil hospital in remote hilly region.
Methods
AIOS was used in quantifying overall severity of illness for eighty-nine consecutive children (age, 2–59 months) hospitalized with community-acquired severe pneumonia. A detailed clinimetric evaluation of scale was carried out and logistic regression analyses predicted the following outcomes: 1) mode of initial antimicrobial therapy (oral vs. parenteral); and 2) need for intravenous fluids at admission.
Results
Majority of children (80.9%) with severe pneumonia scored abnormally (AIOS score >10) at initial evaluation. Children with abnormal AIOS scores (>10) had significantly greater severity of respiratory distress and higher incidence of radiological pneumonia. Outcome measures i.e. time to defervescence and length of hospital stay were also positively and significantly correlated with the scores. The six-item scale had good internal consistency (Cronbach’s alpha 0.81); and its factor analysis yielded a single latent factor explaining 54% of variance in illness severity at admission. Furthermore, logistic regression analyses revealed an independent predictive ability of AIOS in aiding clinician to decide the mode of initial antimicrobial therapy (oral or parenteral), as well as need for intravenous fluids.
Conclusion
Authors study indicates the clinimetric validity of AIOS in managing, Severe childhood pneumonia and suggests its role in further enriching IMCI strategy.
Similar content being viewed by others
References
WHO Programme for the Control of Acute Respiratory Infections. Acute respiratory infections in children: case management in small hospitals in developing countries. Geneva: World Health Organization, 1990.
Nolan T, Angos P, Cunha A JLA, Muhe L, Qazi S, Simoes EAF et al. Quality of hospital care for seriously ill children in less-developed countries. Lancet 2001; 357: 106–110.
Gove S. Integrated management of childhood illness by outpatient health workers: technical basis and overview. Bull World Health Org 1997; 75(suppl 1): S7–S24.
Addo-Yobo E, Chisaka N, Hassan M, Hibberd P, Lozano J M, Jeena P et al. Oral amoxicillin versus injectable penicillin for severe pneumonia in children aged 3 to 59 months: a randomized multicentre equivalency study. Lancet 2004; 364: 1141–1148.
Bang AT, Bang RA, Reddy MH, Baitule SB, Deshmukh MD, Paul VK et al. Simple clinical criteria to identify sepsis or pneumonia in neonates in the community needing treatment or referral. Pediatr Infect Dis J 2005; 24: 335–341.
Bonadio WA. The history and physical assessments of the febrile infant. Pediatr Clin North Am 1998; 45: 65–77.
Weber MW, Usen S, Palmer A, Jaffar S, Mulholland EK. Predictors of hypoxaemia in hospital admissions with acute lower respiratory tract infection in a developing country. Arch Dis Child 1997; 76: 310–314.
McCarthy PL, Jekel JF, Stashwick CA, Spiesel SZ, Dolan TF Jr. History and observation variables in assessing febrile children. Pediatrics 1980; 65: 1090–1095.
McCarthy PL, Jekel JF, Stashwick CA, Spiesel SZ, Dolan TF, Sharpe MR et al. Further definition of history and observation variables in assessing febrile children. Pediatrics 1981; 67: 687–93.
McCarthy PL, Sharpe MR, Spiesel SZ, Dolan TF, Forsyth BW, DeWitt TG et al. Observation scales to identify serious illness in febrile children. Pediatrics 1982; 70: 802–809.
World Health Organization Pneumonia Vaccine Trial Investigators’ Group. Standardization of interpretation of chest radiographs for the diagnosis of pneumonia in children. Geneva: World Health Organization, 2001.
Knapp TR. Coefficient alpha: conceptualizations and anomalies. Res Nurs Hlth 1991; 14: 457–60.
Ferketich S and Muller M. Factor analysis revisited. Nurs Res 1990; 39: 59–62.
Rajesh VT, Singhi S, Kataria S. Tachypnea is a good predictor of hypoxia in acutely ill children. Arch Dis Child 2000; 82: 46–9.
Costello A. Is India ready for the integrated management of childhood illness strategy? Indian Pediatr 1999; 36: 759–62.
McCarthy PL, Lembo RM, Baron MA, Fink HD, Cicchetti DV. Predictive value of abnormal physical examination findings in ill-appearing and well-appearing febrile children. Pediatrics 1985; 76: 167–171.
McCarthy PL, Lembo RM, Fink HD, Baron MA, Cicchetti DV. Observation, history, and physical examination in diagnosis of serious illnesses in febrile children = 24 months. J Pediatr 1987; 110: 26–30.
Baker MD, Avner JR, Bell LM. Failure of infant observation scales in detecting serious illness in febrile, 4-to 8-week-old infants. Pediatrics 1990; 85: 1040–1043.
Teach SJ, Fleisher GR, Occult Bacteremia Study Group. Efficacy of an observation scale in detecting bacteremia in febrile children three to thirty-six months of age, treated as outpatients. J Pediatr 1995; 126: 877–881.
McCarthy PL, Sznajderman SD, Lustman-Findling K, Baron MA, Fink HD, Czarkowski N et al. Mothers’ clinical judgment: a randomized trial of the Acute Illness Observation Scales. J Pediatr 1990; 116: 200–206.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bharti, B., Bharti, S. & Verma, V. Role of Acute Illness Observation Scale (AIOS) in managing severe childhood pneumonia. Indian J Pediatr 74, 27–32 (2007). https://doi.org/10.1007/s12098-007-0022-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-007-0022-1