ASSOCIATION BETWEEN MODIFIED PIRO SCORE AND MORTALITY IN PEDIATRIC PNEUMONIA

Abstract

Background: Pneumonia is still a large contributor to childhood morbidity and mortality, especially in low and middle income countries. Early identification of children at increased risk of death is important to escalate to the next level of care and to prioritise scarce intensive-care resources. A Pneumonia in Children Risk Stratification (PIRO) score with modifications may be a simple way to risk stratify children with pneumonia. Objective: To classify Paediatric Pneumonia patients into risk categories (low moderate and high risk) by modified PIRO scope. To compare the mortality among those risk categories. Method: This was a Descriptive cross-sectional study that was carried out at General Pediatrics ward. University of Child Health Sciences Lahore. from June 2025 to October 2025. Consecutive sampling was done and 170 children less than 18 years old with clinically and radiologically confirmed community-acquired pneumonia were included. A modified PIRO score was carried out on admission and the patient was categorised as low (0-2), moderate (3-4) or high risk (≥5) group. The deaths were reported within 30 days. Chi-square test was used for testing the association between the variables PIRO category and mortality. Results: Of 170 children, 89 (52.4%) were low risk, 58 (34.1%) moderate risk, and 23 (13.5%) high risk. Overall mortality was 18 (10.6%). There was a significant increase in mortality between the low-risk, moderate-risk and high-risk groups (1.1% vs 12.1% vs 43.5% mortality, respectively; χ²=41.2, p<0.001). The mean PIRO scores were significantly higher for non-survivors than for survivors (6.1±1.8 vs. 2.3±1.4, p<0.001). Conclusion: The modified PIRO score showed good association with the one-month mortality and discriminated between children according to the mortality risk. It may be beneficial for risk stratification at an early stage, intensive monitoring and prioritizing care in the ICU in resource limited paediatric facilities.