Correction: Development and Internal Validation of a Predictive Model Including Pulse Oximetry for Hospitalization of Under-Five Children in Bangladesh

Raihana, Shahreen; Dunsmuir, Dustin; Huda, Tanvir; Zhou, Guohai; Rahman, Qazi Sadeq-ur; Garde, Ainara; Moinuddin, Md; Karlen, Walter; Dumont, Guy A.; Kissoon, Niranjan; Arifeen, Shams El; Larson, Charles P.; Ansermino, J. Mark

doi:10.1371/journal.pone.0147560

Cited by 4 publications

(4 citation statements)

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“…The logistic triage model comprised of five objectively measurable (age, heart rate, temperature, oxygen saturation, MUAC) and four easily assessable (difficulty breathing, oedema, pallor, parent concern) predictor variables was developed using hospital admission as an indicator of acuity. Most predictors retained in this model are consistent with previous pediatric triage models ( 29 , 30 ); and international guidelines ( 8 ). Parent concern is not currently included in ETAT + or used as a formal criterion to determine admission status.…”

Section: Discussionsupporting

confidence: 81%

Smart triage: Development of a rapid pediatric triage algorithm for use in low-and-middle income countries

Mawji

Dunsmuir

et al. 2022

Front. Pediatr.

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IntroductionEarly and accurate recognition of children at risk of progressing to critical illness could contribute to improved patient outcomes and resource allocation. In resource limited settings digital triage tools can support decision making and improve healthcare delivery. We developed a model for rapid identification of critically ill children at triage.MethodsThis was a prospective cohort study of acutely ill children presenting at Jinja Regional Referral Hospital in Eastern Uganda. Variables collected in the emergency department informed the development of a logistic model based on hospital admission using bootstrap stepwise regression. Low and high-risk thresholds for 90% minimum sensitivity and specificity, respectively generated three risk level categories. Performance was assessed using receiver operating characteristic curve analysis on a held-out test set generated by an 80:20 split with 10-fold cross validation. A risk stratification table informed clinical interpretation.ResultsThe model derivation cohort included 1,612 participants, with an admission rate of approximately 23%. The majority of admitted patients were under five years old and presenting with sepsis, malaria, or pneumonia. A 9-predictor triage model was derived: logit (p) = −32.888 + (0.252, square root of age) + (0.016, heart rate) + (0.819, temperature) + (−0.022, mid-upper arm circumference) + (0.048 transformed oxygen saturation) + (1.793, parent concern) + (1.012, difficulty breathing) + (1.814, oedema) + (1.506, pallor). The model afforded good discrimination, calibration, and risk stratification at the selected thresholds of 8% and 40%.ConclusionIn a low income, pediatric population, we developed a nine variable triage model with high sensitivity and specificity to predict who should be admitted. The triage model can be integrated into any digital platform and used with minimal training to guide rapid identification of critically ill children at first contact. External validation and clinical implementation are in progress.

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Section: Discussionsupporting

confidence: 81%

Smart triage: Development of a rapid pediatric triage algorithm for use in low-and-middle income countries

Mawji

Dunsmuir

et al. 2022

Front. Pediatr.

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“…1 When coupled with a reliable oxygen supply, monitoring SpO2 with pulse oximetry in low- and middle-income countries (LMICs) has been shown to reduce mortality from pneumonia by as much as 35%. 2 When combined with clinical signs, a low oxygen saturation level is a strong predictor of the need for hospital admission 3 , 4 or death 5 for children with infectious illnesses in LMICs.…”

Section: Introductionmentioning

confidence: 99%

Repeatability of Pulse Oximetry Measurements in Children During Triage in 2 Ugandan Hospitals

Asdo,

Mawji,

Agaba

et al. 2023

Glob Health Sci Pract

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“…1 When coupled with a reliable oxygen supply, monitoring SpO2 with pulse oximetry in low-and middle-income countries (LMICs) has been shown to reduce mortality from pneumonia by as much as 35%. 2 When combined with clinical signs, a low oxygen saturation is a strong predictor of the need for hospital admission, 3,4 or death 5 for children with infectious illnesses in LMICs.…”

Section: Introductionmentioning

confidence: 99%

Repeatability of Pulse Oximetry Measurements in Children During Triage in Two Ugandan Hospitals

Asdo

Mawji

Agaba³

et al. 2022

Preprint

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Background: In low- and middle-income countries, health workers use pulse oximeters for intermittent spot measurements of SpO2. However, the accuracy and reliability when used for spot measurements has not been determined. We evaluated the repeatability of spot measurements, and the ideal observation time of measurement to guide recommendations during spot check measurements. Methods: Two one-minute measurements were done for the 3,903 subjects enrolled in the study, collecting 1Hz SpO2 and signal quality index (SQI) data. The repeatability between the two measurements was assessed using an intraclass correlation coefficient (ICC), calculated using a median of all seconds of non-zero SpO2 values for each recording (any quality, Q1), and again with a quality filter only using seconds with SQI ≥ 90% (good quality, Q2). The ICC was also calculated for both these conditions using subsets of the minute, in increasing increments of 5 seconds, up to the whole minute. Lastly, the whole minute ICC was calculated with good quality (Q2), including only records where both measurements had a mean SQI > 70% (Q3). Findings: The repeatability ICC with condition Q1 was 0.591 (95% confidence interval (CI) = 0.570, 0.611). Using only the first 5 seconds of each measurement reduced the repeatability to 0.200 (95% CI = 0.169, 0.230). Filtering with Q2, the whole minute ICC was 0.855 (95% CI = 0.847, 0.864). The ICC did not improve beyond the first 35 seconds. For Q3, the repeatability rose to 0.908 (95% CI = 0.901, 0.914). Conclusions: Training guidelines must emphasize the importance of signal quality and duration of measurement, targeting a minimum of 35 seconds of adequate-quality, stable data. In addition, the design of new devices should incorporate user prompts and force quality checks to encourage more accurate pulse oximetry measurement.

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Correction: Development and Internal Validation of a Predictive Model Including Pulse Oximetry for Hospitalization of Under-Five Children in Bangladesh

Cited by 4 publications

References 1 publication

Smart triage: Development of a rapid pediatric triage algorithm for use in low-and-middle income countries

Smart triage: Development of a rapid pediatric triage algorithm for use in low-and-middle income countries

Repeatability of Pulse Oximetry Measurements in Children During Triage in 2 Ugandan Hospitals

Repeatability of Pulse Oximetry Measurements in Children During Triage in Two Ugandan Hospitals

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