Pneumonia Risk Stratification Scores for Children in Low-Resource Settings

Deardorff, Katrina; McCollum, Eric D.; Ginsburg, Amy Sarah

doi:10.1097/inf.0000000000001883

Cited by 23 publications

(21 citation statements)

References 26 publications

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“…admission; while low birth weight, stunting, UWFA, HIV exposure, and WHO-defined radiographic consolidation were strongly associated with prolonged hospitalization. Hypoxia has been considered the most important feature of pneumonia severity [5,[22][23][24]. However, in our cohort, peripheral oxygen saturation <92% was a reason to consider hospitalization, and was very common, occurring in 33% of hospitalized cases.…”

Section: Plos Onementioning

confidence: 56%

Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa

et al. 2021

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Background Child hospitalization for pneumonia remains common, and pneumonia is a major cause of child mortality. Early identification of clinical factors associated with serious outcomes may help target risk-mitigation strategies. Methods Pneumonia cases occurring in the Drakenstein Child Health Study, a prospective birth cohort outside Cape Town, South Africa were analysed, and factors associated with serious outcomes of pneumonia were identified. Pregnant women were enrolled antenatally, followed through pregnancy, and mother-child pairs from birth to 2 years. Active surveillance for pneumonia was done. Children hospitalized with pneumonia had chest radiography and blood drawn for inflammatory markers; course, outcome and duration of hospitalization were investigated. Serious outcomes were defined as in-hospital mortality or admission to intensive care unit (ICU). Prolonged hospitalization was also explored as a proxy for severity. Features associated with serious outcomes or prolonged hospitalization were analysed using modified Poisson regression. Results Among 1143 live born infants, there were 174 hospitalized pneumonia events in 133 children under 2 years. Three children (1.7%) died, 14 (8%) required ICU admission for respiratory support. In modified Poisson regression, age < 2 months, preterm birth, or hypoxia (oxygen saturation <92%) were significantly associated with serious outcomes. Preterm birth, low birth weight, HIV exposure, stunting, or underweight-for-age (UWFA) were associated with prolonged hospitalization. Chest radiography, elevated C reactive protein, white blood cell and neutrophil counts were not useful to predict death or ICU admission in children hospitalized with pneumonia. Conclusions In this cohort, death from pneumonia was rare, but clinical features associated with serious outcomes and prolonged hospitalization were identified. These may help with risk stratification, to identify children who may benefit from enhanced monitoring or earlier escalation to respiratory support.

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Section: Plos Onementioning

confidence: 56%

Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa

et al. 2021

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“…Prognostic risk scores have been implemented in resource rich hospital settings to identify children at risk of death [19], and similarly designed scores are now emerging from LMICs [20]. Scores from hospitalized children have been developed using databases from Columbia, Ghana, India, Kenya, Malawi, Mexico, Pakistan, South Africa, Vietnam, and Zambia [21–25].…”

Section: Discussionmentioning

confidence: 99%

Development of a prognostic risk score to aid antibiotic decision-making for children aged 2-59 months with World Health Organization fast breathing pneumonia in Malawi: An Innovative Treatments in Pneumonia (ITIP) secondary analysis

et al. 2019

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Background Due to increasing antimicrobial resistance in low-resource settings, strategies to rationalize antibiotic treatment of children unlikely to have a bacterial infection are needed. This study’s objective was to utilize a database of placebo treated Malawian children with World Health Organization (WHO) fast breathing pneumonia to develop a prognostic risk score that could aid antibiotic decision making. Methods We conducted a secondary analysis of children randomized to the placebo group of the Innovative Treatments in Pneumonia (ITIP) fast breathing randomized, controlled, noninferiority trial. Participants were low-risk HIV-uninfected children 2–59 months old with WHO fast breathing pneumonia in Lilongwe, Malawi. Study endpoints were treatment failure, defined as either disease progression at any time on or before Day 4 of treatment or disease persistence on Day 4, or relapse, considered as the recurrence of pneumonia or severe disease among previously cured children between Days 5 and 14. We utilized multivariable linear regression and stepwise model selection to develop a model to predict the probability of treatment failure or relapse. Results Treatment failure or relapse occurred in 11.5% (61/526) of children included in this analysis. The final model incorporated the following predictors: heart rate terms, mid-upper arm circumference, malaria status, water source, family income, and whether or not a sibling or other child in the household received childcare outside the home. The model’s area under the receiver operating characteristic score was 0.712 (95% confidence interval 0.66, 0.78) and it explained 6.1% of the variability in predicting treatment failure or relapse (R 2 , 0.061). For the model to categorize all children with treatment failure or relapse correctly, 77% of children without treatment failure or relapse would require antibiotics. Conclusion The model had inadequate discrimination to be appropriate for clinical application. Different strategies will likely be required for models to perform accurately among similar pediatric populations.

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“…The ideal respiratory severity score for young children should be quick and straightforward to undertake and interpret. It should not involve complex measurements, complex descriptions, any equipment and should only include non-invasive parameters [6].…”

Section: W H a T I S A L R E A D Y K N O W N ?mentioning

confidence: 99%

“…There is no pre-defined reference standard other than clinical assessment by an expert HCP, which was used in two papers [9,16]. Even if a well validated scale were identified it would not be possible to say, 'this scale is valid', because the most that we can conclude from any one particular study is that 'we have shown the scale to be valid with this group of children, in this context' [6,29]. Therefore, validation needs to be undertaken relative to the population that needs to be measured.…”

Section: Validitymentioning

confidence: 99%

Can a Respiratory Severity Score Accurately Assess Respiratory Distress in Children with Bronchiolitis in a Resource-Limited Setting?

Hakizimana

Saint

Miert

et al. 2019

Journal of Tropical Pediatrics

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Pneumonia Risk Stratification Scores for Children in Low-Resource Settings

Cited by 23 publications

References 26 publications

Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa

Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa

Development of a prognostic risk score to aid antibiotic decision-making for children aged 2-59 months with World Health Organization fast breathing pneumonia in Malawi: An Innovative Treatments in Pneumonia (ITIP) secondary analysis

Can a Respiratory Severity Score Accurately Assess Respiratory Distress in Children with Bronchiolitis in a Resource-Limited Setting?

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