Development and Validation of a Prediction Score for Critical Admission in Children With Dengue

This study aimed to develop and validate a clinical score for the prediction of critical care entrance in children with dengue.

We conducted a retrospective cohort study using admissions from January 2019 to August 2021, at Hospital Infantil Napoleón Franco Pareja, in Cartagena, Colombia. We included all children 18 years or younger, with a positive immunoglobulin M or nonstructural protein 1 laboratory test and admitted for follow-up at the emergency department. We selected variables retrospectively collected on emergency admission for feature selection. We assessed discrimination and calibration in the development dataset, using 1000 bootstrap replications for internal validation. Data from 2019 to 2020 were used for development and 2021 for temporal validation. We report the c -statistic for discrimination with 95% confidence intervals (CIs), as well as the calibration intercept and slope.

One thousand three hundred eighty-five patients were included for development and internal validation. In temporal validation with 519 additional patients, the c -statistic was 0.82 (95% CI: 0.77-0.87), with a calibration slope of 0.98 (95% CI: 0.77-1.18). We selected the 50 th percentile of the distribution of predicted probability of critical care entrance (5%) as a threshold value for increased alert at emergency admission, missing 10% of all cases that need to enter critical care (sensitivity of 90% with 95% CI of 82-95, and specificity of 48% with 95% CI of 41-50).

Our validated model can be useful to predict critical care entrance in children with dengue. We recommend the validation and potential recalibration of our score in other clinical settings.