usefulness of acute illness observation scale (aios) in community acquired pneumonia among ...

112 Pages·2013·2.15 MB·English

“USEFULNESS OF ACUTE ILLNESS OBSERVATION SCALE
(AIOS) IN COMMUNITY ACQUIRED PNEUMONIA AMONG
CHILDREN AGED 2MONTHS TO 59MONTHS”
by
Dr. LINGARAJ MULAGE

Dissertation Submitted to the
Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore
In partial fulfillment of the requirements for the degree of
DOCTOR OF MEDICINE IN PAEDIATRICS
Under the guidance of
Dr. MURALI B H . MBBS, MD
Associate Professor

DEPARTMENT OF PAEDIATRICS
KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES
AND RESEARCH CENTRE
BANGALORE
2013

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Rajiv Gandhi University of Health Sciences, Karnataka

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled “USEFULNESS OF
ACUTE ILLNESS OBSERVATION SCALE (AIOS) IN COMMUNITY
ACQUIRED PNEUMONIA AMONG CHILDREN AGED 2MONTHS TO
59MONTHS ” is a bonafide and genuine research work carried out by me under the
guidance of Dr. MURALI B H, Associate Professor, Kempegowda Institute of
Medical Sciences and Research Centre , Bangalore.

Signature of the Candidate
Date:

Place: Bangalore Dr . LINGARAJ MULAGE

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Rajiv Gandhi University of Health Sciences, Karnataka

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “USEFULNESS OF ACUTE
ILLNESS OBSERVATION SCALE (AIOS) IN COMMUNITY ACQUIRED
PNEUMONIA AMONG CHILDREN AGED 2MONTHS TO 59MONTHS ” is a
bonafide research work done by Dr. LINGARAJ MULAGE in partial fulfillment of
the requirement for the degree of MD PAEDIATRICS

Signature of the Guide
Date:
Dr MURALI B H. MBBS, MD
Place: Bangalore
Associate Professor
Department of Paediatrics
Kempegowda Institute of Medical Sciences
Bangalore

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Rajiv Gandhi University of Health Sciences, Karnataka

ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE
INSTITUTION

This is to certify that the dissertation entitled “USEFULNESS OF ACUTE
ILLNESS OBSERVATION SCALE (AIOS) IN COMMUNITY ACQUIRED
PNEUMONIA AMONG CHILDREN AGED 2MONTHS TO 59MONTHS” is a
bonafide research work done by Dr. LINGARAJ MULAGE under the guidance of
Dr. MURALI B H , Associate Professor , Kempegowda Institute of Medical
Sciences and Research Centre , Bangalore.
.

Seal & Signature of the HOD Seal & Signature of the Principal
Dr A C RAMESH MBBS, Dr M K SUDARSHAN
MD, DCH MD (BHU), F.A.M.S
Professor Principal and Dean
D epartment of Paediatrics Kempegowda Institute of Medical
Kempegowda Institute of Medical Sciences .Bangalore
Sciences.Bangalore

Date:
Date:
Place: Bangalore
Place: Bangalore
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COPYRIGHT

Declaration by the Candidate

I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall
have the rights to preserve, use and disseminate this dissertation / thesis in print or
electronic format for academic / research purpose.

Date: Signature of the Candidate

Place: Bangalore Dr LINGARAJ MULAGE

©Rajiv Gandhi University of Health Sciences, Karnataka
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ACKNOWLEDGMENT
First, I thank God Almighty for all the grace he has bestowed upon me. This
dissertation is the culmination of the help, encouragement and guidance from a
number of people. I would like to thank them all.
It gives me immense pleasure to express my deep sense of gratitude and
indebtedness that I feel towards my teacher and guide Dr. MURALI. B. H, Associate
Professor of Paediatrics, Kempegowda Institute of Medical Sciences and Research
Centre, Bangalore, for his valuable suggestions, guidance, great care and attention to
detail that he has so willingly shown in the preparation of this dissertation. I consider
it to be a discrete privilege to have him as my guide and teacher.
I am extremely thankful to Dr, M. K. SUDARSHAN, Dean, Principal and
Professor of Community medicine, for giving me an opportunity to conduct this
study.
I acknowledge and express my humble gratitude and sincere thanks to my
beloved teacher Dr. A. C. RAMESH, Professor and H.O.D, for his constant help to
undertake this study.
I thank Dr. SURESH, Medical Superintendent, Dr. (Capt.)
G.S.VENKATESH, Medical Director and Dr. VEERANNA, AMO, for allowing me
to conduct this study in their institute.
I owe a great deal of respect and gratitude to Dr. S. R. KESHAVA
MURTHY Professor, Dr. SRINIVASA S, Professor, Dr. YASHODHA .H.T,
Professor, Dr. CHANDRAKALA. P, Associate Professor, Dr. POORNIMA
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SHANKAR, Associate Professor, Department of Paediatrics, for their scholarly
suggestions and allround encouragement.
I am immensely thankful to Dr. MADHU.G.N, Dr. H. S. RAMYA,
Dr. HARISH .J, Dr. SHIVASHARANAPPA, Dr. GIRISH, Dr. SRINIVAS,
Dr. MOHAN KUMAR and Dr. CHAITRA, Assistant Professors in the Department
of Paediatrics for their kind guidance during the course.
I thank Dr. N KRISHNAPPA, MD, HOD and professor and Dr. SANJAY,
Assistant professor in the Department of Radiology for their kind guidance.
I thank Dr. TANVIR, Dr. SHYLAJA and Dr. KALPANA, Senior Residents
in the Department of Paediatrics for their valuable support.
I thank Dr. CHAITRA RAO , Dr. MANJUNATH M. N, Dr.
MANJUNATH V. C, Dr. SANTOSH, Dr. DEVANG, Dr. GIRIJA, Dr.
SHARANYA and all my other Post graduate colleagues for their wholehearted
support.
I shall forever be indebted to my parents, my sisters and my fiancée
DR. Maheshwari for their constant encouragement and support.
I am thankful to Mr PURANDER and Mr. BABU for their cooperation.
Finally, I thank all my patients who formed the back bone of this study without whom
this study would not have been possible.

Date: Signature of the Candidate

Place: Bangalore Dr. LINGARAJ MULAGE

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LIST OF ABBREVIATIONS USED
AIOS - Acute illness observation scale
ARI - Acute respiratory infection
BTS - British Thoracic Society
CAP - Community Acquired Pneumonia
CPS - Capsular Polysaccharide
CRP - C Reactive Protein
CXR - Chest X Ray
DALY - Disability Adjusted Life Year
ESR - Erythrocyte Sedimentation Rate
Hb - Haemoglobin
HIV - Human Immunodeficiency Virus
ICD - Inter Costal Drainage
ICU - Intensive Care Unit
IDSA - Infectious Disease Society of America
IGME - Inter-Agency Group for Child Mortality Estimation
IMCI - Integrated Management of Childhood Illness
IMNCI - Integrated Management of Neonatal and Childhood Illness
IPD - Invasive Pneumococcal Disease
MDG - Millennium Developmental Goal
O2 - Oxygen
ORT - Oral Rehydration Therapy
PCR - Polymerase Chain Reaction
PCT - Procalcitonin
RR - Respiratory Rate
RSV - Respiratory Syncytial Virus
SBI - Severe Bacterial Infection
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SD - Standard Deviation
S.pneumoniae - Streptococcal Pneumoniae
SpO2 - Oxygen Saturation
SPSS - Statistical Product and Service Solutions
UNICEF - United Nations International Children's Emergency Fund
VATS - Video -Assisted Thoracoscopic Surgery
WBC - White Blood Cells
WHO - World Health Organization

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ABSTRACT

BACKGROUNG AND OBJECTIVES
Community acquired pneumonia(CAP) continue to be the leading cause for
morbidity and mortality of infant and young children and pneumonia ranking first
among causes of under five mortality in India. IMNCI is found to be an effective
strategy for case management in acute childhood respiratory illness which will be
more effective in managing pneumonia when supplemented by an illness severity
scoring system. In this regard use of Acute Illness Observation Score (AIOS)-an
illness severity scale developed by P.L.McCarthy based on simple observation which
focuses on six easily observed factors when taken together act as sensitive indicator of
severity of illness in children. In this background the present study was undertaken to
validate AIOS in predicting illness severity and clinical outcome of community
acquired pneumonia.
METHODOLOGY
This was a descriptive epidemiological study conducted on children in
age group of 2months-59months, with clinical features of pneumonia as per WHO
recommendations. IMNCI and Acute Illness Observation Scale (AIOS) scoring is
applied on each subject to assess the severity of community acquired pneumonia.
Respiratory parameters, vitals signs, investigations, treatment and disease course are
documented and statistical analysis was done.