Predicting Mortality among Hospitalized Children with Respiratory Illness in Western Kenya, 2009–2012

Abstract

BackgroundPediatric respiratory disease is a major cause of morbidity and mortality in the developing world. We evaluated a modified respiratory index of severity in children (mRISC) scoring system as a standard tool to identify children at greater risk of death from respiratory illness in Kenya.Materials and MethodsWe analyzed data from children <5 years old who were hospitalized with respiratory illness at Siaya District Hospital from 2009–2012. We used a multivariable logistic regression model to identify patient characteristics predictive for in-hospital mortality. Model discrimination was evaluated using the concordance statistic. Using bootstrap samples, we re-estimated the coefficients and the optimism of the model. The mRISC score for each child was developed by adding up the points assigned to each factor associated with mortality based on the coefficients in the multivariable model.ResultsWe analyzed data from 3,581 children hospitalized with respiratory illness; including 218 (6%) who died. Low weight-for-age [adjusted odds ratio (aOR) = 2.1; 95% CI 1.3–3.2], very low weight-for-age (aOR = 3.8; 95% CI 2.7–5.4), caretaker-reported history of unconsciousness (aOR = 2.3; 95% CI 1.6–3.4), inability to drink or breastfeed (aOR = 1.8; 95% CI 1.2–2.8), chest wall in-drawing (aOR = 2.2; 95% CI 1.5–3.1), and being not fully conscious on physical exam (aOR = 8.0; 95% CI 5.1–12.6) were independently associated with mortality. The positive predictive value for mortality increased with increasing mRISC scores.ConclusionsA modified RISC scoring system based on a set of easily measurable clinical features at admission was able to identify children at greater risk of death from respiratory illness in Kenya.

Predicting Hospitalised Paediatric Pneumonia Mortality Risk: An External Validation of RISC and mRISC, and Local Tool Development (RISC-Malawi) from Malawi

“…Two tools have been proposed to identify hospitalized children at risk of death due to acute respiratory illness: the Respiratory Index of Severity in Children (RISC) [11] and modified Respiratory Index of Severity in Children (mRISC) [12]. RISC was developed retrospectively from a dataset collected in Soweto, South Africa from 1998–2001 in hospitalized children aged 0–24 months enrolled in a pneumococcal conjugate vaccine (PCV) randomized controlled trial, post Haemophilus influenzae type b (Hib) vaccine introduction with known HIV disease status.…”

Efficiency of Respiratory Index in Determining Short-Term Prognosis of Multiple Trauma Patients: A Cross-Sectional Study

“…Then, Emukule et al designed a modified version of this system for children under 5 years in 2014 and revealed that with an increase in this index, mortality rates also increased. They succeeded in predicting which children were more susceptible to death due to respiratory tract diseases (18). Therefore, we can conclude that although RI can be used as an injury severity factor due to its significant correlation with RTS, it cannot correctly estimate the short-term prognosis of multiple trauma patients.…”

Prognostic models for predicting in-hospital paediatric mortality in resource-limited countries: a systematic review

“…Despite inadequate reporting of the models’ performance, 16 models reported AUCs ≥0.80, an indication of promising models. Apart from the following exceptions; Lambarene Organ Dysfunction score, 21 PEDIA score, 19 Signs of Inflammation in Children that Kill (SICK) score, 36 Respiratory Index of Severity in Children (RISC) score 18 and modified RISC score, 23 other prognostic models in this review have not been externally validated (by independent investigators using diverse populations). Only two studies 24 37 developing four models provided a full model formula (both coefficients and intercept/baseline function) in their results as recommended.…”