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Validity of Clinical Severity Scores for Respiratory Syncytial Virus: A Systematic Review
Zakariya Sheikh1, Ellie Potter1, You Li2
1Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, United Kingdom.
Insights
No current severity scores for respiratory syncytial virus (RSV) in children are sufficiently validated. Further research is needed to confirm the reliability of existing RSV scoring systems for accurate disease assessment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Epidemiology
Background:
- Respiratory syncytial virus (RSV) is a major cause of pediatric respiratory hospitalizations.
- Existing RSV severity scores lack consensus on clinical utility.
- Accurate disease severity assessment is crucial for pediatric respiratory infections.
Purpose of the Study:
- To systematically review and assess the validity of pediatric RSV severity scores.
- To identify the most promising and well-validated scores for clinical use.
- To evaluate the quality of reporting and risk of bias in studies of RSV severity scores.
Main Methods:
- Systematic review of English-language publications since 2000.
- Inclusion criteria: children ≤24 months with RSV/bronchiolitis, assessment of score validity.
- Quality assessment using TRIPOD and PROBAST checklists.
Main Results:
- 32 articles and 31 scores were included in the review.
- No assessed scores met the predefined criteria for sufficient validation.
- Reporting and design quality of included studies were generally poor.
- The Bronchiolitis Score of Sant Joan de Déu showed promise but required further validation.
Conclusions:
- Current RSV severity scores are not sufficiently validated for pediatric use.
- Further research with larger datasets is essential to validate existing scores.
- Improved validation is needed to establish reliable tools for assessing RSV disease severity.
Background:
Respiratory syncytial virus (RSV) is a widespread respiratory pathogen, and RSV-related acute lower respiratory tract infections are the most common cause of respiratory hospitalization in children <2 years of age. Over the last 2 decades, a number of severity scores have been proposed to quantify disease severity for RSV in children, yet there remains no overall consensus on the most clinically useful score.
Methods:
We conducted a systematic review of English-language publications in peer-reviewed journals published since January 2000 assessing the validity of severity scores for children (≤24 months of age) with RSV and/or bronchiolitis, and identified the most promising scores. For included articles, (1) validity data were extracted, (2) quality of reporting was assessed using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis checklist (TRIPOD), and (3) quality was assessed using the Prediction Model Risk Of Bias Assessment Tool (PROBAST). To guide the assessment of the validity data, standardized cutoffs were employed, and an explicit definition of what we required to determine a score was sufficiently validated.
Results:
Our searches identified 8541 results, of which 1779 were excluded as duplicates. After title and abstract screening, 6670 references were excluded. Following full-text screening and snowballing, 32 articles, including 31 scores, were included. The most frequently assessed scores were the modified Tal score and the Wang Bronchiolitis Severity Score; none of the scores were found to be sufficiently validated according to our definition. The reporting and/or design of all the included studies was poor. The best validated score was the Bronchiolitis Score of Sant Joan de Déu, and a number of other promising scores were identified.
Conclusions:
No scores were found to be sufficiently validated. Further work is warranted to validate the existing scores, ideally in much larger datasets.
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