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Published on: February 17, 2023
External Validation of Pediatric Pneumonia and Bronchiolitis Risk Scores to Predict Mortality in Children
Becky Gordon1,2, Joyce U Nyiro3, Harish Nair1,4,5
1Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom.
Insights
The RISC-Malawi score, using mid-upper arm circumference, best predicted mortality in Kenyan children hospitalized with acute lower respiratory tract infections (ALRIs). Other scores also showed fair performance, highlighting potential for improved risk stratification.
Area of Science:
- Pediatric Infectious Diseases
- Global Health
- Clinical Epidemiology
Background:
- Acute lower respiratory tract infections (ALRIs) are a major cause of death in children in low- and middle-income countries.
- Effective risk stratification tools are crucial for improving outcomes in resource-limited settings.
- This study evaluated pediatric ALRI risk scores for mortality prediction in Kenyan children.
Purpose of the Study:
- To analyze the performance of six established pediatric ALRI risk scores in predicting in-hospital mortality.
- To assess the utility of a modified ReSVinet score incorporating nutritional status.
- To identify the most promising risk score for implementation in Kenyan healthcare settings.
Main Methods:
- Retrospective analysis of 2182 children (2-24 months) hospitalized with severe ALRIs in Kenya.
- Evaluation of six risk scores: RISC (HIV-Negative), mRISC, RISC-Malawi, PERCH, PREPARE, and ReSVinet.
- Assessment of a modified ReSVinet score including nutritional status; discrimination measured by AUROC.
Main Results:
- The RISC-Malawi score, utilizing mid-upper arm circumference (MUAC), demonstrated the highest predictive discrimination (AUROC: 0.83).
- All evaluated scores showed acceptable discrimination (AUROC: 0.70-0.79).
- Modifying the ReSVinet score with nutritional status significantly improved its predictive performance (AUROC increased from 0.72 to 0.79).
Conclusions:
- All assessed risk scores exhibited at least fair performance in predicting in-hospital mortality.
- The RISC-Malawi (MUAC) score is a strong candidate for future implementation due to its superior predictive ability.
- Further research is necessary to evaluate the calibration, feasibility, and clinical utility of these scores in practice.
Background:
Acute lower respiratory tract infections (ALRIs) are a leading cause of pediatric mortality in low- and middle-income countries. In recent years, substantial research has been done to enhance risk stratification of children presenting with ALRIs, in a bid to improve health outcomes in resource-limited settings. We sought to analyze the performance of several pediatric ALRI risk scores in the prediction of mortality among children hospitalized with ALRIs in Kenya.
Methods:
We retrospectively analyzed the data of 2182 children aged 2-24 months who were admitted to Kilifi County Referral Hospital, Kenya with severe ALRIs between January 2015 and December 2024. We evaluated the performance of 6 ALRI risk scores (RISC [HIV-negative], mRISC, RISC-Malawi, PERCH, PREPARE, and ReSVinet) in this population. Additionally, we created and evaluated a modified version of the ReSVinet score by including nutrition status. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC).
Results:
The mid-upper arm circumference (MUAC) version of the RISC-Malawi score showed the highest discrimination for the outcome of in-hospital mortality (AUROC, 0.83; 95% confidence interval, .79-.86), whilst all other scores showed acceptable discrimination (AUROC, 0.70-0.79). The modification of ReSVinet to include nutrition status significantly improved its AUROC from 0.72 to 0.79.
Conclusions:
All risk scores showed at least fair performance in the prediction of in-hospital mortality within our dataset. The RISC-Malawi (MUAC) score appears to be the most promising candidate for future implementation; however, further research is needed to evaluate the calibration, feasibility, and clinical utility of these scores.
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