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Published on: January 27, 2019
Clinical prognostic models in children with sepsis in low- and middle-income countries: a systematic review and
Jessica Jordan1, Celinie M Nguyen1, Lauren M Fletcher2
1Warren Alpert Medical School, Brown University, Providence, RI, United States.
Insights
This systematic review found few validated clinical scores for pediatric sepsis in low- and middle-income countries (LMICs). Further research is needed to adapt and validate these prognostic models for resource-limited settings.
Area of Science:
- Pediatric critical care
- Global health
- Epidemiology
Background:
- Sepsis is a leading cause of child mortality globally, predominantly in low- and middle-income countries (LMICs).
- Effective prognostic scores are crucial for risk-stratification and management of pediatric sepsis.
Purpose of the Study:
- To systematically review and meta-analyze clinical prognostic scores for pediatric sepsis outcomes.
- To assess the performance of these scores in predicting mortality in LMICs.
Main Methods:
- Searched multiple databases (Ovid Medline, CINAHL, Cochrane Library, EBSCO Global Health, Web of Science) up to September 2022.
- Included studies on the development or validation of clinical prognostic scores for pediatric sepsis in LMICs.
- Assessed risk of bias using the Prediction Model Risk of Bias Assessment Tool (PROBAST).
Main Results:
- 12 studies met inclusion criteria, from countries including India, China, Egypt, Indonesia, Tanzania, and Latin America.
- Commonly studied scores included PELOD-2, pSOFA, PRISM, and P-MODS.
- Meta-analysis showed pooled AUC for pSOFA (0.86) and PELOD-2 (0.83), despite high risk of bias in all studies.
Conclusions:
- Limited external validation of pediatric sepsis prognostic scores exists for LMICs, with no studies from low-income countries.
- Standardized sepsis criteria and further research are needed to validate and adapt models for resource-limited settings.
- External validation and implementation of these models are essential for improving pediatric sepsis outcomes in LMICs.
Introduction:
Sepsis is the leading cause of child death worldwide, with the majority of these deaths occurring in low- and middle-income countries (LMICs). The aim of this systematic review and meta-analysis was to describe clinical prognostic scores and models for pediatric sepsis outcomes and assess the performance of these scores for predicting mortality in LMICs.
Methods:
Ovid Medline, CINAHL, Cochrane Library, EBSCO Global Health, and Web of Science, were searched through September 2022 for citations related to the development or validation of a clinical prognostic score or model among children with sepsis, conducted in LMIC. Titles, abstracts, and full texts were screened by two independent reviewers and data extracted included population characteristics, variables included, outcomes, and model performance. Risk of bias was assessed with the Prediction Model Risk of Bias Assessment Tool (PROBAST).
Results:
4,251 titles/abstracts and 315 full-text studies were screened, with 12 studies meeting inclusion criteria. Study countries included India, China, Egypt, Indonesia, Tanzania, and a multi-site study in Latin America. Prognostic scores/models included existing scores such as PELOD-2, pSOFA, PRISM, P-MODS, refractory shock criteria. There was high risk of bias in all studies. Meta-analysis was possible for pSOFA, PELOD-2, PRISM, and P-MODS, with pooled area under the receiver-operator characteristic curve of 0.86 (95%CI 0.78-0.94), 0.83 (95% CI 0.76-0.91), respectively.
Conclusion:
Relatively few clinical scores and models have been externally validated for prognostication and risk-stratification among children with sepsis in diverse LMIC settings. Notably there were no studies from low-income countries. Some potentially relevant studies were excluded due to lack of clarity regarding the presence of sepsis in the study populations. More widespread and standardized use of sepsis criteria may aid in better understanding the burden of sepsis and prognostic model performance at the bedside among children in LMICs. Further research to externally validate, implement and adapt these models is needed to account for challenges in use of these scores in resource-limited settings.
Systematic Review Registration:
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022340126, PROSPERO [CRD42022340126].
