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Predicting mortality among hospitalized children with respiratory illness in Western Kenya, 2009-2012
Gideon O Emukule1, Meredith McMorrow2, Chulie Ulloa3
1Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya.
Insights
A new modified respiratory index of severity in children (mRISC) score effectively identifies Kenyan children at high risk of death from respiratory illness. This tool aids in early detection and intervention for pediatric respiratory diseases.
Area of Science:
- Global Health
- Pediatrics
- Epidemiology
Background:
- Pediatric respiratory disease is a significant cause of death in developing nations.
- Accurate risk stratification is crucial for managing severe pediatric respiratory illness.
- The study focuses on identifying at-risk children in Kenya.
Purpose of the Study:
- To evaluate a modified respiratory index of severity in children (mRISC) scoring system.
- To establish a standard tool for identifying children at high risk of mortality from respiratory illness in Kenya.
- To improve clinical decision-making for pediatric respiratory cases.
Main Methods:
- Analysis of data from 3,581 children under 5 hospitalized with respiratory illness in Kenya (2009-2012).
- Development of a multivariable logistic regression model to identify mortality predictors.
- Calculation of the mRISC score based on factors associated with in-hospital mortality.
Main Results:
- Low weight-for-age, unconsciousness, inability to drink/breastfeed, chest wall in-drawing, and reduced consciousness were key predictors of mortality.
- The mRISC score demonstrated increasing positive predictive value for mortality with higher scores.
- The model showed good discrimination for predicting in-hospital death.
Conclusions:
- The modified RISC scoring system (mRISC) effectively identifies children at increased risk of death from respiratory illness.
- Easily measurable clinical features at admission form the basis of the mRISC score.
- This tool can aid in risk stratification and management of pediatric respiratory diseases in resource-limited settings.
Background:
Pediatric respiratory disease is a major cause of morbidity and mortality in the developing world. We evaluated a modified respiratory index of severity in children (mRISC) scoring system as a standard tool to identify children at greater risk of death from respiratory illness in Kenya.
Materials And Methods:
We analyzed data from children <5 years old who were hospitalized with respiratory illness at Siaya District Hospital from 2009-2012. We used a multivariable logistic regression model to identify patient characteristics predictive for in-hospital mortality. Model discrimination was evaluated using the concordance statistic. Using bootstrap samples, we re-estimated the coefficients and the optimism of the model. The mRISC score for each child was developed by adding up the points assigned to each factor associated with mortality based on the coefficients in the multivariable model.
Results:
We analyzed data from 3,581 children hospitalized with respiratory illness; including 218 (6%) who died. Low weight-for-age [adjusted odds ratio (aOR) = 2.1; 95% CI 1.3-3.2], very low weight-for-age (aOR = 3.8; 95% CI 2.7-5.4), caretaker-reported history of unconsciousness (aOR = 2.3; 95% CI 1.6-3.4), inability to drink or breastfeed (aOR = 1.8; 95% CI 1.2-2.8), chest wall in-drawing (aOR = 2.2; 95% CI 1.5-3.1), and being not fully conscious on physical exam (aOR = 8.0; 95% CI 5.1-12.6) were independently associated with mortality. The positive predictive value for mortality increased with increasing mRISC scores.
Conclusions:
A modified RISC scoring system based on a set of easily measurable clinical features at admission was able to identify children at greater risk of death from respiratory illness in Kenya.
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