Assessment the Severity of Pneumonia Using Pediatric Respiratory Severity Score (PRESS) at Salah Aldeen General Hospital

Abstract

Backgrownd : Pneumonia  is  a significant   causes of   respiratory   morbidity    and  mortality  in  children    especially  in  developing  countries worldwide is the  leading  causes  of  death  in  children  younger  than 5 year. Sever pneumonia characterized by high fever and difficulty breathing and can be fatal it is critical there fore to assess   the severity of condition  during initial  bedside assessment  in emergency department by using  pediatric respiratory severity score. The PRESS score which depend on respiratory rate ,wheezing ,accessory muscle use  ,spo2 and  difficulty feeding.  
Aim: This study done to evaluate the role of The Pediatric respiratory severity score ( PRESS) as screening test for assessment of severity of pneumonia.  Patient and method: Convenient sample hospital based selective  study  done on  patient  attending emergency department at Salah Aldeen General  Hospital who complain from  shortness of  breathing  during  the period from  May 2017  to 
13November 2017 .The  study included 52  children  there age from 0-60 month  .Each  patient  included  in  the  study    were  assessed  by  prepared questionnaire from   parents  include (name ,age ,sex, residence ,type of feeding screening done by  general examination including respiratory rate and sings of dyspnia that include tachypnea , use of  accessory muscle,  wheeze ,and  chest indrawing  . Each   patient  examined  for chest   examination  looking  for crepitation  and  ronchi  ,each  patient  where  assessed    by  Acute  Respiratory infection  World  health  Organization  program  (  ARI)  .  Each  patient  also  assessed      by    pediatric  respiratory  severity  score  (PRESS)  that  include  respiratory rate wheezing , accessory muscle use , feeding  difficulties ,and  SPO2 level  above 95%.And each patient assessed  by community acquired pneumonia (CAP) score. The  diagnosis  of  pneumonia   when done by CXR  with x-ray  report from experience radiologist . 
Results:  The total number of cases 52 case32 (62%) male and 20  (38% )female. Most of study cases from urban 31  (60%) and age 3-12 month age was23 (44%)  most of cases had   tachypnea 35(67%)  and with bottle feeding 28(54%). Most of cases had history of upper respiratory tract infection 42(81%) and 30(58%) of cases not taken vaccination. According to community acquired pneumonia  ( CAP) severity  score. Most of cases with mild to moderate  CAP 29 (56%) and  according to  acute respiratory infection (ARI) program found most of cases with very severe illness  28(54%) and according to pediatric respiratory  severity  score  PRESS  where  found  most  of  cases  with  sever pneumonia 26 (50%) according to radiological finding  most of cases where multifocal pneumonia 24 (46%). 
Conclusion:  The PRESS was sensitive as ARI score but the specoificity was similar to CAP score . So it is recommended that the use of  PRESS score  for assessment of pneumonis in children 0-6 months age.