The use of a special clinical score and platelet count for assessment of severity and outcome of children with acute lower respiratory tract infection

Introduction
Lower respiratory tract infections (LRTIs) are a major threat to the health of children worldwide and are exacerbated by global environmental problems. In the developing countries where nutrition remains poor, LRTIs are the most common cause of death in children. However, although the incidence of LRTI in developed countries is as low as 3–4%, its incidence in developing countries ranges between 20 and 30%. Up to 13% of in-patient deaths in pediatric wards are due to LRTI.
Patients and methods
This is a prospective study conducted in Assiut University Children Hospital during the period from November 2017 to February 2018. A total of 100 infants and children aged 1 month to 2 years old were included in the study. The patients were classified into two categories: severe pneumonia and very severe pneumonia or very severe disease according to the presence or absence of general danger signs reported by WHO 2014. All cases were subjected to Temperature, Oxygen saturation, Pulse rate, Respiratory rate, Sensorium loss and Seizures (TOPRS) clinical score, platelet count, and chest radiography.
Results
Overall, 69% of cases were males and 31% of cases were females; 49% of cases were aged 1–6 months, 31% of cases were aged 6–12 months, and 20% of cases were aged 12–24 months; and 73% of cases were discharged, whereas 27% of cases died in the hospital.
Conclusion
A special clinical scoring system called TOPRS score is developed. It is a simple clinical scoring system that depends on physical variables only (temperature, oxygen saturation, pulse rate, respiratory rate, sensorium, and seizures), and it can be used mainly to improve the triage in the emergency room to detect the severity of cases presented and to initiate appropriate emergency treatment in time. It is also helpful to predict outcome of the selected cases. Thrombocytopenia is a good indicator for poor outcome of cases of LRTI, being more powerful than thrombocytosis.