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Identifying risk of death in children hospitalized with community-acquired pneumonia
Shally Awasthi1, Anuj Kumar Pandey1, Shambhavi Mishra1
1Department of Pediatrics, King George's Medical University, Shah Mina Road, Lucknow, Uttar Pradesh-226003, India.
Insights
The PREPARE tool effectively identifies children hospitalized with community-acquired pneumonia at high risk of death. External validation in India confirms its utility for early risk assessment and referral.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Risk Stratification
- Public Health Interventions
Background:
- Community-acquired pneumonia (CAP) is a leading cause of child mortality globally.
- Accurate risk assessment is crucial for timely intervention in hospitalized children with CAP.
- The PREPARE tool was developed to identify children at risk of death from CAP.
Purpose of the Study:
- To externally validate the PREPARE tool for identifying the risk of death in children hospitalized with CAP.
- To assess the discriminatory ability of the PREPARE tool in a northern Indian cohort.
Main Methods:
- Secondary analysis of hospital-based surveillance data (January 2015 - February 2022) of children aged 2-59 months with CAP.
- Multivariable logistic regression used to assess PREPARE variables' association with pneumonia-related death.
- Sensitivity, specificity, and likelihood ratios calculated for the PREPARE score at various cut-offs.
Main Results:
- 6745 children were included; 1.4% died.
- Factors associated with death included young age, female sex, severe underweight, elevated respiratory rate, lethargy, convulsions, cyanosis, and low oxygen saturation.
- The PREPARE score achieved a sensitivity of 79.6% and specificity of 72.5% at a cut-off of ≥5, with an AUC of 0.82.
Conclusions:
- The PREPARE tool, incorporating pulse oximetry, demonstrated good discriminatory ability upon external validation in northern India.
- The tool can effectively assess the risk of death in hospitalized children aged 2-59 months with CAP.
- This facilitates early referral to higher-level healthcare facilities for improved outcomes.
Objective:
To externally validate a tool developed by the Pneumonia Research Partnership to Assess WHO Recommendations study group for identification of the risk of death in children hospitalized with community-acquired pneumonia, the PREPARE tool.
Methods:
We did a secondary analysis of data collected during hospital-based surveillance of children with community-acquired pneumonia in northern India from January 2015 to February 2022. We included children aged 2-59 months with pulse oximetry assessment. We used multivariable backward stepwise logistic regression analysis to assess the strength of association of the PREPARE variables (except hypothermia) with pneumonia-related death. We estimated sensitivity, specificity, and positive and negative likelihood ratios of the PREPARE score at cut-off scores ≥ 3, ≥ 4 and ≥ 5.
Findings:
Of 10 943 children screened, 6745 (61.6%) were included in our analysis, of whom 93 (1.4%) died. Age of < 1 year, female sex, weight-for-age < -3 standard deviations, respiratory rate of ≥ 20 breaths/min higher than the age-specific cut-off, and lethargy, convulsions, cyanosis and blood oxygen saturation < 90% were associated with death. In the validation, the PREPARE score had the highest sensitivity (79.6%) with concurrent highest specificity (72.5%) to identify hospitalized children at risk of death from community-acquired pneumonia at a cut-off score of ≥ 5. Area under curve was 0.82 (95% confidence interval: 0.77-0.86).
Conclusion:
The PREPARE tool with pulse oximetry showed good discriminatory ability on external validation in northern India. The tool can be used to assess risk of death of hospitalized children aged 2-59 months with community-acquired pneumonia for early referral to higher-level facilities.
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