Comparison of Modified Predisposition, Insult, Response, Organ dysfunction (PIRO) score and Respiratory Index of Severity in Children (RISC) score in prediction of severity of paediatric pneumonia: A cross-sectional comparative study
Keywords:
Pediatric Pneumonia, Modified Piro Score, Respiratory Index Of Severity In Children Score, Risk StratificationAbstract
Background: Pneumonia remains a leading cause of morbidity and mortality in children, especially in low- and middle-income countries. Early identification of severe cases is essential to improve outcomes. This study aimed to evaluate the prognostic utility of two pediatric pneumonia severity scoring systems, modified PIRO and RISC in a tertiary care setting in South India.
Objectives: To compare modified PIRO scoring system with RISC scoring system in prediction of severity of pneumonia in children in a tertiary care hospital in Kolar.
Methodology: This cross-sectional comparative study was conducted in RL Jalappa Hospital, Department of Pediatrics between March 2025 to May 2025.Children who came to the hospital with pneumonia were included in this study. The collected data underwent statistical analysis.
Results: Of the 80 patients, 23 (28.8%) were categorized as severe by the modified PIRO score, with a mortality rate of 47.8%. The Modified PIRO score demonstrated a sensitivity of 84.6%, specificity of 82.0% and a negative predictive value (NPV) of 96.4%. In comparison, 29 patients (36.2%) had a RISC score ≥3, with a 34.5% mortality rate, sensitivity of 76.9%, specificity of 71.6% and NPV of 94.1%. Both scoring systems showed a statistically significant association with outcomes (p < 0.001).
Conclusion: The modified PIRO score showed superior prognostic performance and is better suited for hospital-based triage due to its comprehensive, multi-system assessment. The RISC score, though slightly less predictive, offers practical value in low-resource settings as a simple, clinical tool. A context-sensitive, stratified triage approach using these scoring systems can enhance the management and outcomes of pediatric pneumonia.
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