Comparison of the Canadian vs. the international risk scoring tool for respiratory syncytial virus prophylaxis in moderate-to-late preterm infants
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Published on: January 26, 2019
Michelle Butt1,2, LouAnn Elliott3, Fiona Guy3
1School of Nursing, McMaster University, Hamilton, ON, Canada.
Insights
The international risk scoring tool (IRST) is a faster alternative to the Canadian risk scoring tool (CRST) for identifying infants needing respiratory syncytial virus (RSV) prophylaxis. IRST identifies more moderate-risk infants for RSV hospitalization prevention.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Respiratory Syncytial Virus (RSV) poses a significant health risk to infants, particularly those born prematurely.
- Current risk scoring tools, like the Pediatric Investigators Collaborative Network on Infections in Canada risk scoring tool (CRST), help determine eligibility for RSV prophylaxis.
- The development of new, potentially more efficient tools is crucial for optimizing preventative care.
Purpose of the Study:
- To compare the efficacy and efficiency of the newly developed International Risk Scoring Tool (IRST) against the established CRST.
- To evaluate the performance of both tools in identifying infants (33-35 weeks gestational age) at risk for RSV-related hospitalization.
- To assess the number of infants categorized as moderate risk for RSV hospitalization by each tool.
Main Methods:
- A prospective study involving 556 infants born during 2018-2021 RSV seasons (33-35 weeks gestational age).
- Infants were scored using both the CRST (7 variables) and IRST (3 variables) to predict RSV hospitalization risk.
- Spearman rank correlation was used to analyze the correlation between total scores and risk category ranks of the two tools.
Main Results:
- Total risk scores between CRST and IRST showed moderate correlation (r=0.64, p<0.001).
- A significant relationship was found between the risk category ranks of both tools (r=0.53, p<0.001).
- The IRST categorized a higher proportion of infants as moderate risk (28.1%) compared to the CRST (19.6%).
Conclusions:
- The IRST offers a more time-efficient alternative to the CRST due to its fewer variables.
- The IRST identifies a larger cohort of moderate-risk infants who may benefit from RSV prophylaxis.
- Further cost-utility and cost comparison analyses are recommended before widespread adoption of the IRST.
Aim:
The study objective was to compare the Pediatric Investigators Collaborative Network on Infections in Canada risk scoring tool (CRST) that determines need for respiratory syncytial virus (RSV) prophylaxis in infants 33-35 weeks gestational age during the RSV season, with the newly developed international risk scoring tool (IRST).
Methods:
Children 33-35 weeks gestational age born during the 2018-2021 RSV seasons were prospectively identified following birth and scored with the validated CRST and IRST, that comprises seven and three variables respectively, into low- moderate- and high-risk groups that predict RSV-related hospitalization. Correlations between total scores on the two tools, and cut-off scores for the low-, moderate- and high-risk categories were conducted using the Spearman rank correlation.
Results:
Over a period of 3 RSV seasons, 556 infants were scored. Total risk scores on the CRST and the IRST were moderately correlated (r = 0.64, p < 0.001). A significant relationship between the risk category rank on the CRST and the risk category rank on the IRST (r = 0.53; p < 0.001) was found. The proportion of infants categorized as moderate risk for RSV hospitalization by the CRST and IRST were 19.6% (n = 109) and 28.1% (n = 156), respectively.
Conclusion:
The IRST may provide a time-efficient scoring alternative to the CRST with three vs. seven variables, and it selects a larger number of infants who are at moderate risk for RSV hospitalization for prophylaxis. A cost-utility analysis is necessary to justify country-specific use of the IRST, while in Canada a cost comparison is necessary between the IRST vs. the currently approved CRST prior to adoption.
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