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BMC Pediatr. 2018 Oct 30;18(1):339. doi: 10.1186/s12887-018-1317-2.

The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department.

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Department of Paediatrics and Child Health, AKU, Karachi, Pakistan.
Department of Emergency Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Paediatrics, Länssjukhuset Gävle-Sandviken, 801 87, Gävle, Sweden.
Department of Emergency Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.



Respiratory distress is a common presenting complaint in children brought to the Emergency Department (ED). The Clinical Respiratory Score (CRS) has shown promise as a screen for severe illness in High Income Countries. We aimed to validate the admission CRS in children presenting to the ED of a Low-to Middle Income Country.


Children (1 month to 16 years) presenting with respiratory distress to the ED of the Aga Khan University Hospital, Karachi, Pakistan, between November 2015 to March 2016, were enrolled. The CRS was measured at initial presentation, prior to any management and 2 h after treatment was started. The predictive value for admission to the paediatric critical care units for a variety of cut offs for CRS at presentation were derived.


A total of 112 children (70% male) of median age 12 months (IQR 2, 34.5 months) were enrolled. Patients with severe CRS (score 8-12) at presentation were more likely to be admitted to paediatric critical care (90% vs. 23% with mild-moderate CRS; OR: 5.7; 95% CI: 2.2-15.3, p < 0.001). The sensitivity and specificity of CRS > 3 in predicting outcome were 94% (95% CI 79.8-99.3) and 40% (95% CI 35-45), respectively, with a positive likelihood ratio of 1.6 (95% CI 1.31-1.98) and negative predictive value of 94% (95% CI 81-98).


An admission CRS of > 3 in the ED of a Low-to Middle Income Country had excellent predictive value for disease severity, and it should be considered for incorporation into ED triage protocols.


Clinical respiratory score (CRS); Low to middle income country (LMIC); Paediatric ICU; Paediatric emergency department; Paediatric respiratory distress; Paediatrics; Respiratory distress

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