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External validation of an admission risk score for predicting inpatient paediatric mortality in two Kenyan public
Stephen Kamau1,2, Joyce Kigo1, Michuki Maina1
1Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya.
Insights
This study validated an admission risk score to predict child mortality in hospitals in low- and middle-income countries. The score moderately identified high-risk children, aiding early interventions to prevent pediatric mortality.
Area of Science:
- Pediatric Medicine
- Global Health
- Clinical Risk Prediction
Background:
- In low- and middle-income countries (LMICs), early identification of children at risk of mortality during hospitalization is critical.
- This study aimed to externally validate an existing admission risk score for predicting inpatient pediatric mortality in resource-limited settings.
Purpose of the Study:
- To validate an admission risk score for predicting inpatient pediatric mortality in resource-limited settings.
- To assess the score's performance in identifying high-risk children for targeted interventions.
Main Methods:
- Retrospective analysis of routine clinical data from 15,606 children (≤12 years) admitted to two Kenyan public hospitals (2017-2023).
- Utilized a 13-predictor admission risk score to categorize children into low (score 0), moderate (1-4), and high (≥5) risk categories.
- Assessed predictive performance using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and predictive values at different cutoffs.
Main Results:
- The risk score demonstrated moderate discrimination, with an AUC of 0.73 (95% CI: 0.71-0.75).
- High-risk children (score ≥5) had a significantly higher mortality rate (23.4%) compared to low-risk children (2%).
- A cutoff score of ≥3 provided a balance between sensitivity (63.8%) and specificity (72.2%) for identifying at-risk children.
Conclusions:
- The validated admission risk score moderately predicts inpatient pediatric mortality in Kenyan public hospitals.
- The risk score can be a valuable tool, alongside clinical assessment, for rapid identification of high-risk children.
- This facilitates targeted interventions to prevent pediatric mortality in resource-limited settings.
Background:
Early identification of children at risk of mortality during hospitalization is crucial in preventing mortality in low-and middle-income countries (LMICs). This study aimed to externally validate an admission risk score for predicting inpatient paediatric mortality in resource-limited settings.
Methods:
This retrospective study utilized routine clinical data of children aged ≤12 years admitted to two Kenyan public hospitals between January 2017 and October 2023. The admission risk score includes 13 clinical predictors, each assigned a value. Aggregate values were used to predict inpatient pediatric mortality, with a higher score indicating a greater risk of death. Children with scores of 0, 1-4 and ≥5 were categorized as low, moderate and high-risk categories, respectively. Discrimination was assessed using area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative predictive values were calculated at different cutoff points.
Results:
A total of 15,606 children were included in the study. Majority of the participants were male (8,847, 56.7%) and aged 12 - 59 months (7,222, 46.3%). Children classified as high-risk had a higher mortality rate (23.4%) than those classified as low risk (2%). The risk score demonstrated moderate discrimination, with an AUC of 0.73 (95% confidence interval (CI): 0.71 - 0.75). A cutoff of ≥3 achieved a balance between sensitivity and specificity, with values of 63.8% (95% CI: 60.7%-66.9%) and 72.2% (95% CI: 71.5% - 72.9%), respectively, compared to other cutoff points.
Conclusion:
The risk score performed moderately in predicting inpatient paediatric mortality in two Kenyan public hospitals. The risk score can be used with other clinical assessments to rapidly identify high-risk children and guide targeted interventions to prevent mortality.
