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Mortality predictive scores for community‐acquired pneumonia in children

To the Editor: Community-Acquired Pneumonia (CAP) is one of the leading cause of deaths in children younger than 5 years old in developing countries. Around one million children died from pneumonia in 2013. For this reason, the importance to use mortality predictive scores in pneumonia for children is paramount, just as the use of adult population scores that evaluate the severity of pneumonia such as CURB-65, PSI, or SMART-COP among others. Despite the necessity, it is not frequent to use mortality predictive scores for pneumonia within developing countries. In accordance with the previous statement, in our non-systematic bibliographic research for the currently available scores, we have found three severity scores in pediatric populations, the Respiratory Index of Severity Score (RISC), the Pediatric Respiratory Severity Score (PRESS), and the Predisposition, Insult, Response, Organ dysfunction modified (PIROm) which are compared in Table 1. First, the RISC score was validated in pediatric populations of South Africa, in which a prospective study was conducted in children, both affected and not affected with HIV. The score was designed to evaluate only clinical criteria to determine the severity of pneumonia in both populations separately. Secondly, the PRESS score was validated in a prospective study composed of pediatric patients in a Japanese hospital, to evaluate the severity of respiratory tract infections. This study uses the clinical criteria of the RISC score as the basis of its concept. The PRESS score, unlike the RISC score, is an instrument exclusively for the general pediatric population. Finally, the PIROm score was validated in Paraguay in a retrospective study. The PIROm score does not only evaluate clinical criteria, but also collects radiological and laboratory data obtained from clinical records. Moreover, this score is the only instrument created from another score used from the adult population (PIRO). The main problem is the scarcity of information about scores that assess the severity of pneumonia in pediatric patients, its application and use in different populations, and their usefulness implementation in different levels of health care. In developing countries, there is a need to identify the severe patients who need referral to a more complex hospital for a comprehensive treatment, as opposed to the patients that can be managed ambulatory. Scores such as RISC or PRESS which evaluates clinical criteria would be the most suitable for such application. Thus, scores may provide a quick assessment of sick patients in primary care facilities, in resourced-limited countries with barriers to hospital