Related Experiment Video
Updated: Apr 6, 2026
A Ferret Model of Inflammation-sensitized Late Preterm Hypoxic-ischemic Brain Injury
Published on: November 19, 2019
Predicting mortality in sick African children: the FEAST Paediatric Emergency Triage (PET) Score
Elizabeth C George1, A Sarah Walker2, Sarah Kiguli3
1Medical Research Council Clinical Trials Unit (MRC CTU) at UCL, London, UK. elizabeth.george@ucl.ac.uk.
Insights
A new risk score for sick children in African emergency units can quickly identify those most at risk of death. This FEAST Paediatric Emergency Triage (PET) score aids in rapid assessment and improved outcomes.
Area of Science:
- Paediatric Emergency Medicine
- Clinical Risk Stratification
- Global Health
Background:
- High mortality rates in African paediatric emergency units, often within 24 hours of admission.
- Need for practical bedside risk scores to complement triage systems and reduce mortality.
Purpose of the Study:
- To develop and validate a clinical bedside risk score for identifying severely ill children at high risk of mortality in African emergency settings.
- To identify key clinical and laboratory prognostic factors for mortality in this population.
Main Methods:
- Analysis of data from the multi-centre Fluid As Expansive Supportive Therapy (FEAST) trial involving 3,170 severely ill African children.
- Development of a multivariable Cox regression model using bedside clinical parameters.
- External validation of the derived risk score in independent datasets and comparison with existing risk scores.
Main Results:
- An 8-variable clinical risk score (FEAST PET score) was developed, ranging from 0-10.
- The score demonstrated good discriminative ability (AUROC 0.77-0.86) in validation datasets, comparable to or better than existing scores.
- Lactate, blood urea nitrogen, and pH were identified as important additional laboratory prognostic factors.
Conclusions:
- The FEAST Paediatric Emergency Triage (PET) score is a validated tool for rapid bedside risk assessment in African paediatric emergency care.
- The score effectively discriminates children at highest risk of fatal outcomes upon hospital admission.
- Additional laboratory markers can further refine risk assessment and severity indexing.
Background:
Mortality in paediatric emergency care units in Africa often occurs within the first 24 h of admission and remains high. Alongside effective triage systems, a practical clinical bedside risk score to identify those at greatest risk could contribute to reducing mortality.
Methods:
Data collected during the Fluid As Expansive Supportive Therapy (FEAST) trial, a multi-centre trial involving 3,170 severely ill African children, were analysed to identify clinical and laboratory prognostic factors for mortality. Multivariable Cox regression was used to build a model in this derivation dataset based on clinical parameters that could be quickly and easily assessed at the bedside. A score developed from the model coefficients was externally validated in two admissions datasets from Kilifi District Hospital, Kenya, and compared to published risk scores using Area Under the Receiver Operating Curve (AUROC) and Hosmer-Lemeshow tests. The Net Reclassification Index (NRI) was used to identify additional laboratory prognostic factors.
Results:
A risk score using 8 clinical variables (temperature, heart rate, capillary refill time, conscious level, severe pallor, respiratory distress, lung crepitations, and weak pulse volume) was developed. The score ranged from 0-10 and had an AUROC of 0.82 (95 % CI, 0.77-0.87) in the FEAST trial derivation set. In the independent validation datasets, the score had an AUROC of 0.77 (95 % CI, 0.72-0.82) amongst admissions to a paediatric high dependency ward and 0.86 (95 % CI, 0.82-0.89) amongst general paediatric admissions. This discriminative ability was similar to, or better than other risk scores in the validation datasets. NRI identified lactate, blood urea nitrogen, and pH to be important prognostic laboratory variables that could add information to the clinical score.
Conclusions:
Eight clinical prognostic factors that could be rapidly assessed by healthcare staff for triage were combined to create the FEAST Paediatric Emergency Triage (PET) score and externally validated. The score discriminated those at highest risk of fatal outcome at the point of hospital admission and compared well to other published risk scores. Further laboratory tests were also identified as prognostic factors which could be added if resources were available or as indices of severity for comparison between centres in future research studies.