Volume 14, Issue 2 (2-2026)                   JoMMID 2026, 14(2): 137-148 | Back to browse issues page

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Saini M, Bhooshan S, Rathore L, Saini M. Prognostic Factors and Utility of the RISC Score Among Children with Community-Acquired Pneumonia Admitted to a Pediatric Intensive Care Unit at a Tertiary Care Hospital. JoMMID 2026; 14 (2) :137-148
URL: http://jommid.pasteur.ac.ir/article-1-718-en.html
Prognostic Factors and Utility of the RISC Score Among Children with Community-Acquired Pneumonia Admitted to a Pediatric Intensive Care Unit at a Tertiary Care Hospital
Monika Saini , Suneel Bhooshan , Laxmi Rathore , Mahendra Saini *
Department of Orthopaedics, Fortis Hospital, Jaipur, Rajasthan, India
Abstract:   (6 Views)
Introduction: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality among children. We aimed to evaluate the demographic, clinical, vaccination status, comorbidity profiles, and microbiological findings of children aged 1 month to 12 years with CAP admitted to a pediatric intensive care unit (PICU), and to assess the utility of the Respiratory Index of Severity in Children (RISC) score in predicting in-hospital mortality. Methods: This retrospective, observational study was conducted at SMS Medical College, Jaipur, India, from January 2019 to January 2021. Of 352 screened children, 322 meeting the WHO Integrated Management of Childhood Illness (IMCI) pneumonia definition were enrolled. Blood cultures were processed using the BD BACTEC FX system; isolates were identified by VITEK®2. Antimicrobial susceptibility testing followed Clinical and Laboratory Standards Institute M100-Ed31 guidelines. The RISC score was calculated at PICU admission. The chi-square test, Fisher's exact test, and independent t-test were used; a P value < 0.05 was considered statistically significant. Results: Among 322 children (70.2% male), in-hospital mortality was 5.9% (19/322). Age and sex were not significantly associated with mortality. Complete vaccination including pneumococcal conjugate vaccine (PCV) was protective (P < 0.001). Oxygen saturation (SpO₂) < 90% was significantly associated with mortality (P = 0.002). Non-survivors had higher mean RISC scores (2.05 ± 1.58 vs. 0.86 ± 1.32; P < 0.001). At a RISC score cut-off of ≥ 3, sensitivity was 52.6%, specificity 81.9%, and negative predictive value 96.5%. Blood culture positivity was 35.1% (113/322); 79 isolates (24.5% of all enrolled children) were pathogenic. All 19 deaths occurred in culture-positive children; no mortality was observed among those with sterile cultures. The highest mortality rates were observed with Escherichia coli (66.7%, 2/3), Klebsiella pneumoniae (41.2%, 7/17), and Streptococcus pneumoniae (37.5%, 3/8) bacteremia. Conclusion: Complete vaccination, SpO₂ < 90%, and the RISC score were significant prognostic factors. The RISC score demonstrated high negative predictive value for identifying children at low risk of mortality. Early blood culture collection and expanded vaccination coverage may improve outcomes in resource-limited settings.
Keywords: Antimicrobial resistance, Blood culture, Children, Community-acquired pneumonia, Mortality, Pediatric intensive care unit, Prognostic factors, RISC score
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Type of Study: Original article | Subject: Anti-microbial agents, resistance and treatment protocols
Received: 2025/03/19 | Accepted: 2026/02/21 | Published: 2026/09/7
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.