The Use of Acute Illness Observation Scales (AIOS) to Predict Serious Illiness in Children with Fever: A Preliminary Study

One of the most common reasons for a sick child visit is fever. When evaluating an acutely ill, febrile child, pediatricians must be aware about the probability of serious illness and can identify those requiring specific interventions. The objective of this study was to evaluate the diagnostic value of Acute Illness Observation Scale (AIOS) to identify serious illness in children visiting the General Pediatric Clinic, CMH, Jakarta. This was a prospective study carried out in 2008. Subjects were children aged 2 month - 18 years with fever (axillary temperature of >37.8oC). Every subject was observed using the AIOS instrument before clinical examination. The diagnosis of serious illnesses was established based on the gold standard of particular diseases. The sensitivity, specificity, predictive values, and likelihood ratio of AIOS were calculated. Thirty-five subjects (median age 27 months old) fulfilled the eligibility criteria, 20 of them were boys. Nineteen subjects were diagnosed to suffer from serious illness, i.e lung abscess (1), dengue hemorrhagic fever (1), typhoid fever (4), urinary tract infection (10), and otitis media (3). There was a statistically significant difference in mean AIOS score between subjects with serious illness compared to those without [12.52 (SD 4.2) vs. 8.38 (SD 3.0), p =0.002]. The AIOS had sensitivity of 79%, specificity 62.5%, positive and negative predictive values 71%, and positive likelihood ratio of 2.1 in identifying serious illnesses in our subjects. The AIOS instrument might become a valuable screening tool to identify serious illnesses in children with fever. It needs further validation in studies with larger sample size.