Yale Observation Score for Prediction of Critical Illness in 3-36 Months Old Febrile Children

INTRODUCTION- Combining the laboratory tests with a pediatricians self-judgmental score is thought to aid in diagnosing serious illness. Yale Observation Scale is one such observational score studied worldwide. STUDY DESIGN- Prospective, hospital based, cross- sectional study MATERIAL AND METHODS- 100 consecutive children 3-36 months of age with rectal temperaturegreater than101 F were enrolled and YOS scoring done. This was followed by physical examination and extensive laboratory testing with CBC, PBF, Urine and stool routine/microscopy, chest x-ray, CRP, ESR and blood cultures. The primary outcome was analysis of sensitivity, specificity, positive and negative predictive values of YOS scale in predicting critical illness while the secondary outcome was determination of vital parameters and laboratory findings which could reflect as red flag signs for critical illness. RESULTS- YOS score of 10 on the ROC curve had 92.3 % Sensitivity, 44.2 % Specificity, Positive Predictive Value (PPV) 51.4 % and Negative Predictive Value (NPV) 90 % for intensive care requirement as demonstrated by percentage PICU admissions while with respect to clinical outcome, it had a sensitivity of 100.0 %, specificity of 32.9 %, PPV 12.86 % and NPV 100 %. Mean heart rates and respiratory rates were statistically positive red flags while mean temperature elevation, TLC, ESR and CRP levels had negative results. CONCLUSION- YOS score is very useful in ruling out critical illness in 3-36 months age group at cut-off value of 10 while only significantly higher scores (greater than16) depict essentially serious illness and poorer outcome.