title: Application of a Prognostic Scale to Estimate the Mortality of Children Hospitalized with Community-acquired Pneumonia.
abstract: BACKGROUND
  Pneumonia is a major cause of mortality in children. The objective of this study was to construct a prognostic scale for estimation of mortality applicable to children with community-acquired pneumonia (CAP).
  
  
  METHODS
  This observational study included patients younger than 15 years with a diagnosis of CAP who were hospitalized between 2004 and 2013. A point-based scoring system based on the modification of the PIRO scale used in adults with pneumonia was applied to each child hospitalized with CAP. It included the following variables: predisposition (age <6 months, comorbidity), insult [hypoxia (O2 saturation < 90), hypotension (according to age) and bacteremia], response (multilobar or complicated pneumonia) and organ dysfunction (kidney failure, liver failure and acute respiratory distress syndrome). One point was given for each feature that was present (range, 0-10 points). The association between the modified PIRO score and mortality was assessed by stratifying patients into 4 levels of risk: low (0-2 points), moderate (3-4 points), high (5-6 points) and very high risk (7-10 points).
  
  
  RESULTS
  Eight hundred sixty children hospitalized with CAP were eligible for study. The mean age was 2.8 ± 3.2 years. The observed mortality was 6.5% (56/860). Mortality ranged from 0% for a low PIRO score (0/708 pts), 18% (20/112 pts) for a moderate score, 83% (25/30 pts) for a high score and 100% (10/10 pts) for a very high modified PIRO score (P < 0.001).
  
  
  CONCLUSIONS
  The present score accurately discriminated the probability of death in children hospitalized with CAP, and it could be a useful tool to select candidates for admission to intensive care unit and for adjunctive therapy in clinical trials.
authors.affiliation: From the *Department of Pediatrics, Institute of Tropical Medicine, Avda. Venezuela y Florida, Asunción, Paraguay; and †Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Av. Mcal. Francisco Solano Lopez, San Lorenzo, Paraguay.
authors.forename: Soraya
authors.initials: S
authors.lastname: Araya
authors.forename: Dolores
authors.initials: D
authors.lastname: Lovera
authors.forename: Claudia
authors.initials: C
authors.lastname: Zarate
authors.forename: Silvio
authors.initials: S
authors.lastname: Apodaca
authors.forename: Julia
authors.initials: J
authors.lastname: Acuña
authors.forename: Gabriela
authors.initials: G
authors.lastname: Sanabria
authors.forename: Antonio
authors.initials: A
authors.lastname: Arbo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D010239:Paraguay / Q000453:epidemiology; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D011379:Prognosis; D012372:ROC Curve; D013902:Radiography, Thoracic; D012720:Severity of Illness Index