Independent Validation of an Existing Model Enables Prediction of Hearing Loss after Childhood Bacterial Meningitis

Abstract

ObjectiveThis study aimed external validation of a formerly developed prediction model identifying children at risk for hearing loss after bacterial meningitis (BM). Independent risk factors included in the model are: duration of symptoms prior to admission, petechiae, cerebral spinal fluid (CSF) glucose level, Streptococcus pneumoniae and ataxia. Validation helps to evaluate whether the model has potential in clinical practice.Study design116 Dutch school-age BM survivors were included in the validation cohort and screened for sensorineural hearing loss (>25 dB). Risk factors were obtained from medical records. The model was applied to the validation cohort and its performance was compared with the development cohort. Validation was performed by application of the model on the validation cohort and by assessment of discrimination and goodness of fit. Calibration was evaluated by testing deviations in intercept and slope. Multiple imputation techniques were used to deal with missing values.ResultsRisk factors were distributed equally between both cohorts. Discriminative ability (Area Under the Curve, AUC) of the model was 0.84 in the development and 0.78 in the validation cohort. Hosmer-Lemeshow test for goodness of fit was not significant in the validation cohort, implying good fit concerning the similarity of expected and observed cases. There were no significant differences in calibration slope and intercept. Sensitivity and negative predicted value were high, while specificity and positive predicted value were low which is comparable with findings in the development cohort.ConclusionsPerformance of the model remained good in the validation cohort. This prediction model might be used as a screening tool and can help to identify those children that need special attention and a long follow-up period or more frequent auditory testing.

Polymorphisms in Toll-Like Receptors 2, 4, and 9 Are Highly Associated with Hearing Loss in Survivors of Bacterial Meningitis

“…Both cohorts were described in detail in other studies [44], [45]. Both cohorts appeared to be rather similar [46] and no significant differences in genotype distributions were observed between both cohorts. Only Dutch Caucasian survivors of PM and MM were selected for this study.…”

Single Nucleotide Polymorphisms in Pathogen Recognition Receptor Genes Are Associated with Susceptibility to Meningococcal Meningitis in a Pediatric Cohort

“…Secondly, this knowledge may be implemented in clinical practice, for example the identification and targeted vaccination of high susceptible people. Another option is to add genetic severity risk factors to existing prediction models for hearing loss and academic or behavioral limitations after surviving BM [17], [41], [42]. In the future, this process might be fueled by the field of Public Health Genomics, involved in this translation and “the responsible and effective translation of genome-based knowledge and technologies into public policy and health services for the benefit of population health” (Bellagio statement, 2005: see www.graphint.org for details) [43], [44].…”

Repeated Audiometry After Bacterial Meningitis: Consequences for Future Management

“…Furthermore, clinical characteristics of patients were not taken into account. Therefore, we cannot confirm hearing loss due to known associations with clinical characteristics, such as ataxia, S. pneumoniae as causative pathogen, low cerebrospinal fluid glucose level, absence of petechial, or longer duration of symptoms before admission ( 20 ).…”