Mortality Predictive Scores for Community-Acquired Pneumonia in Children

Arbo, Antonio; Lovera, Dolores; Martínez-Cuellar, Celia

doi:10.1007/s11908-019-0666-9

Cited by 8 publications

(6 citation statements)

References 68 publications

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“…These risk scores have not been widely validated using data from low- and middle-income settings outside sub-Saharan Africa [ 8 , 9 ]. The RISC score for HIV-negative children had fair discriminatory value when retrospectively applied to the PERCH and RISC-Malawi data sets, both of which were done after the pneumococcal vaccine became available and large scale prevention of mother to child transmission of HIV implementation [ 6 , 7 ].…”

mentioning

confidence: 99%

External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia

Rees¹,

Hooli²,

King³

et al. 2021

J Glob Health

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Background Existing scores to identify children at risk of hospitalized pneumonia-related mortality lack broad external validation. Our objective was to externally validate three such risk scores. Methods We applied the Respiratory Index of Severity in Children (RISC) for HIV-negative children, the RISC-Malawi, and the Pneumonia Etiology Research for Child Health (PERCH) scores to hospitalized children in the Pneumonia REsearch Partnerships to Assess WHO REcommendations (PREPARE) data set. The PREPARE data set includes pooled data from 41 studies on pediatric pneumonia from across the world. We calculated test characteristics and the area under the curve (AUC) for each of these clinical prediction rules. Results The RISC score for HIV-negative children was applied to 3574 children 0-24 months and demonstrated poor discriminatory ability (AUC = 0.66, 95% confidence interval (CI) = 0.58-0.73) in the identification of children at risk of hospitalized pneumonia-related mortality. The RISC-Malawi score had fair discriminatory value (AUC = 0.75, 95% CI = 0.74-0.77) among 17 864 children 2-59 months. The PERCH score was applied to 732 children 1-59 months and also demonstrated poor discriminatory value (AUC = 0.55, 95% CI = 0.37-0.73). Conclusions In a large external application of the RISC, RISC-Malawi, and PERCH scores, a substantial number of children were misclassified for their risk of hospitalized pneumonia-related mortality. Although pneumonia risk scores have performed well among the cohorts in which they were derived, their performance diminished when externally applied. A generalizable risk assessment tool with higher sensitivity and specificity to identify children at risk of hospitalized pneumonia-related mortality may be needed. Such a generalizable risk assessment tool would need context-specific validation prior to implementation in that setting.

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mentioning

confidence: 99%

External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia

Rees¹,

Hooli²,

King³

et al. 2021

J Glob Health

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“…Children with pneumonia may present with numerous signs and symptoms such as fever, cough, tachypnea, breathing difficulty, wheezing, headache, abdominal pain, and chest pain. Thorough assessments of clinical symptoms and risk factors are very important to determine outcome of the diseases and to identify children who require hospitalization and even intensive care [3]. Using a scoring system can help determine the severity of pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Modified PIRO (predisposition, insult, response, organ dysfunction) severity score as a predictor for mortality of children with pneumonia in Hasan Sadikin Hospital, Bandung, Indonesia

et al. 2021

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Background: Clinical manifestations for pneumonia vary from mild to severe. The PIRO model (predisposition, insult, response, organ dysfunction) was used as scoring system to determine severity of sepsis and pneumonia in adult patients. The PIRO model was modified for sorting the severity of pneumonia in children and predicting its risk of mortality.Methods: An ambispective cohort study of pneumonia patients aged 1 month ≤18 years admitted over the period from May to September 2020. Data were collected from history, physical examination, laboratory examination, and chest radiography. Based on bivariate analysis (p<0.05 and relative risk (RR) with 95% confidence interval), variables of each PIRO component that were significant for mortality were assigned a value of 1. The cut-off score for predictor of mortality was calculated using the receiver operating characteristics (ROC) curve. Stratify the score into three degrees of risk based on interquartile range. Score ≤Q1 is categorized as low risk; Q1-Q3 is categorized as moderate risk; and score >Q3 is categorized as high risk.Results: Out of the 80 subjects subjects enrolled, 6 months-5 years was the largest age group (56.3%). The observed mortality was 15/80 (18.8%). The modified PIRO severity score was compiled from significant variable of predisposition (malnutrition), insult (chest radiograph), response (hypoxemia, hypotension, CRP >0.5 mg/dL, PCT >0.5 ng/dL) and organ dysfunction, with range of score 0-7. Score >3 as a cutoff point score for predictor of mortality with AUC 0.919 (95% CI 0.836–0.968), sensitivity of 80%, and specificity of 84.62%. Subjects with score >3 have RR of 10.544 compared to those with score ≤3. The stratification of score level was low (≤2), moderate (3-4), and high (5-7). The mortality levels were 0%, 46.7%, and 53.3%, respectively.Conclusions: Modified PIRO severity score can be used as a sorting tool and predictor of mortality risk in children with pneumonia. This score can also be used to select candidates for intensive care, especially in health facilities with limited intensive care capacity.

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“…We focused on the gram positive bacterium Streptococcus pneumoniae (SP) which is among the major responsible of severe forms of bacterial infectious diseases [1,22,23,24]. In particular, serotype 19F (SP19F) is one of the most common causes of invasive pneumococcal disease in children, and included in the current commercial pneumococcal conjugate vaccines.…”

Section: Introductionmentioning

confidence: 99%

Exploring calixarene-based clusters for efficient functional presentation of Streptococcus pneumoniae saccharides

Giuliani

Faroldi

Morelli

et al. 2019

Bioorganic Chemistry

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Mortality Predictive Scores for Community-Acquired Pneumonia in Children

Cited by 8 publications

References 68 publications

External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia

External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia

Modified PIRO (predisposition, insult, response, organ dysfunction) severity score as a predictor for mortality of children with pneumonia in Hasan Sadikin Hospital, Bandung, Indonesia

Exploring calixarene-based clusters for efficient functional presentation of Streptococcus pneumoniae saccharides

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