Abstract

MIRANDA-CANDELARIO, Javier Francisco et al. Utility of Moreno’s bacterial pneumonia score in the management of pneumonia in children. Acta méd. peruana [online]. 2015, vol.32, n.3, pp.157-163. ISSN 1728-5917.

Objective. To describe the current management of pneumonia in children in a level III hospital and compared it with Moreno’s scale for clinical-radiological diagnostic prediction of bacterial pneumonia (Bacterial Pneumonia Score -BPS-). Patients and method. Retrospective and descriptive study, from June 2009 to June 2010; it includes all children with pneumonia, from 1 month to 5 years, hospitalized in Pediatrics Service of Emergency Hospital III Grau. Epidemiological records were produced. Chest radiographs were evaluated by two pediatricians and a radiologist, accordingly to Moreno’s BPS, to distinguish bacterial (BP) from viral pneumonia (VP). BP is considered if a score ≥ 4. Statistical analysis was performed with SPSS v15, using bivariate analysis and chi-square test to assess the association; also, the kappa coefficient for interobserver agreement. Results. 149 patients were evaluated, with no differences by sex. 50% were under one year and 24% were between 1 and 2 years. Clinical features showed insidious onset in 92% of patients, none came in dangerous status. In children with chest wall recession, in 70% it was mild. The oxygen saturation was 92%, on average; 97% did not present any complication. The disease duration was 4,7 days and the improvement, 1,7 days. 40% had fever; 87% were diagnosed as bronchopneumonia and acute bronchial obstructive syndrome and 11,4%, pneumonia; 47,7% had wheezing; 17,6%, subcrepitants, and only 13,4%, crackles. Most commonly used antibiotics were ampicillin (48,3%). In applying Moreno’s BPS, 31% had ≥ 4 points. The degree of concordance in evaluating radiographs according to the Moreno’s scale, was good, with kappa > 0,7. Conclusions. Half of the children who were hospitalized for pneumonia were less than a year old. According to the BPS, only 31% had BP; i,e., there was over-diagnosis of BP. According to the clinical, diagnostic aid tests and clinical evolution, about 70% have actually been hospitalized viral pneumonia. Moreno’s BPS is practical and useful to predict the diagnosis of BN.

Keywords : pneumonia; bacterial pneumonia; children; clinical-radiological scale; Moreno’s Bacterial Pneumonia Score; diagnostic prediction.

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