Role of Acute Illness Observation Scale (AIOS) in managing severe childhood pneumonia.
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.


CONCLUSIONS
Authors study indicates the clinimetric validity of AIOS in managing, Severe childhood pneumonia and suggests its role in further enriching IMCI strategy.
Bharti
Bhavneet
B
Civil Hospital Rohru, District Shimla, Himachal Pradesh, India. bhavneetb@yahoo.com
Bharti
Sahul
S
Verma
Vandna
V
D000208:Acute Disease; D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy; D019033:Delivery of Health Care, Integrated; D017723:Drug Utilization Review; D005260:Female; D005500:Follow-Up Studies; D006767:Hospitals, District / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006801:Humans; D007194:India; D007223:Infant; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy*; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents