How a Clinical Respiratory Score helps to decide critical care for children in the ER

Abstract

Acute respiratory illnesses represent a significant portion of the global disease burden, particularly in pediatric populations, where it remains one of the leading causes of illness and death. Conditions such as asthma, which affects approximately 10% of children, and acute respiratory infections significantly contribute to mortality and place a heavy strain on healthcare systems¹.

In children, the signs of respiratory distress can range from mild symptoms, such as a faster-than-normal breathing rate, to severe manifestations like intercostal retractions and cyanosis². Despite its impact, standardized methods for assessing and managing pediatric respiratory distress remain underdeveloped. Although several respiratory scoring systems are available, many lack rigorous validation, particularly in terms of their reliability and clinical relevance. Additionally, these tools often target specific age groups or conditions, limiting their applicability in diverse clinical scenarios³.

There is a pressing need for a validated, user-friendly tool to assess respiratory distress severity across all pediatric age groups and varied clinical environments. The Clinical Respiratory Score (CRS) is a promising tool that evaluates respiratory distress using a combination of clinical parameters, such as respiratory rate, oxygen saturation, wheezing, and mental status. It is designed to provide a systematic and quantifiable method for grading the severity of respiratory distress, facilitating uniform decision-making across various clinical settings. By assigning scores to key clinical signs, the CRS enables healthcare providers to stratify patients based on the severity of their condition, identify those at risk of deterioration, and prioritize interventions accordingly^4,5.

While the CRS has demonstrated potential in high-income countries for conditions like asthma and acute chest syndrome, its validation in low- and middle-income countries (LMICs) across a broader range of respiratory conditions is still limited. Examining its utility in diverse clinical settings, including presentations not directly related to respiratory illnesses, is essential for establishing its broader relevance and adoption in emergency department (ED) triage protocols⁶. The study aimed to improve the triage and management of pediatric patients with respiratory distress in the emergency department by applying the Clinical Respiratory Score.