Comparison of Acute Illness Observation Scale (AIOS) & Chest X-Ray in Children with Acute Respiratory Infection

Acute respiratory infection (ARI) is a major source of morbidity and mortality in both the developing and developed worlds and remains the most important cause of hospital visit. For the early recognition of severity and prompt treatment of ARI, Acute illness observation scale (AIOS) an illness severity scale developed by P.L.McCarthy on the basis of simple observation was used in the current study. This study is a hospital based cross-sectional study conducted in 40 children aged between 2 month to 59 month with ARI. AIOS score was calculated for every child, classified according to Integrated Management of Neonatal and Childhood Illness (IMNCI) and Chest X-ray (CXR) was taken on the day of evaluation and the results were correlated. On the basis of the AIOS score the children were stratified. The relationship between AIOS score and the X-ray abnormalities were studied. There were 27 children who scored 10 with no signs of respiratory distress. In the 6 children who scored 11-15 there was mild to moderate distress and there were 7 children with severe distress who scored >=16. In the X-ray, radiological abnormalities like pneumonia, hyperinflation and pleural effusion was present in 32 children of which 59.4% of children scored <=10, 18.8% scored 11-15 and 21.9% of the children scored >=16. The prevalence of radiological pneumonia among the study population was 72.5%, out of which non end point consolidation (51.73%) was the most common radiological type of pneumonia. On illness severity as assessed by IMNCI classification severe pneumonia (40%) was the most common followed by pneumonia (37.5%) and no pneumonia (22.5). On statistical analysis it was found that AIOS score is not Significant in predicting abnormal radiological findings (P value=0.119) however there is significant association between AIOS scoring and IMNCI classification of ARI in illness severity assessment (P value<0.001). Further AIOS scoring was 100% specific in predicting pneumonia, severe pneumonia or both. However it has sensitivity of 93.8% in predicting severe pneumonia, less sensitive (13.3%) in predicting pneumonia and has sensitivity of 54.8% in predicting both pneumonia and severe pneumonia. It has highest accuracy (96%) in predicting severe pneumonia whereas 45.8% accuracy in predicting pneumonia and 65% accuracy in predicting pneumonia and severe pneumonia in ARI in under 5 children.