Development and an initial validation of the Responses to Illness Severity Quantification (RISQ) score for severely malnourished children

Abstract

Aim:To develop and perform an initial validation of a score to measure the severity of illness in hospitalised children with severe acute malnutrition (SAM).Methods: A prospective study enrolled SAM children aged 6-59 months hospitalised in Borno State, Nigeria. Candidate items associated with inpatient mortality were combined and evaluated as candidate scores. Clinical and statistical methods were used to identify a preferred score. Results:The 513 children enrolled had a mean age of 15.6 months of whom 48 (9%) died. Seven of the 10 evaluated items were significantly associated with mortality. Five different candidate scores were tested. The final score, Responses to Illness Severity Quantification (RISQ), included seven items: heart rate, respiratory rate, respiratory effort, oxygen saturation, oxygen delivery, temperature and level of consciousness.The mean RISQ score on admission was 2.6 in hospital survivors and 7.3 for children dying <48 h. RISQ scores <24 h before death had an area under the receiver operating characteristic curve (AUROC) of 0.93. The RISQ score performed similarly across differing clinical conditions with AUROCs 0.77-0.98 for all conditions except oedema.

Paediatric early warning systems in low‐income settings—Putting the pieces together

“…This tool aims to identify which children among those admitted to a Nigerian hospital with severe acute malnutrition that face a high risk of mortality. 1 The early detection of patients who are at risk of deteriorating is sensible and can assist health care professionals to prioritise patients. This is particularly important in resource-limited settings that manage high numbers of patients with limited resources and staff.…”

“…Dale et al state that RISQ score only represents one part of the RISQ system that the authors are developing. 1 The full package will be similar to the Bedside PEWS system, as it will include recommendations for care that are matched to local resources and integrated throughout the spectrum of care. This will be an interesting | 1659 EDITORIAL continuation of present study and will allow us to evaluate the true clinical value of the RISQ scoring system.…”

“…It provides recommendations for care escalation and de‐escalation in hospitalised patients aged 0–18 years 4 . In the Dale et al version, 1 blood pressure and capillary refill time have been replaced by temperature and level of consciousness. The authors also decided to exclude mid‐upper arm circumference and oedema, which have been associated with poor outcomes in malnourished children in other studies.…”

Issue highlights September 2022

“…The Responses to Illness Severity Quantification scoring tool aims to identify which children admitted to hospital with severe acute malnutrition face the highest risk of mortality. Dahl et al evaluated the use of the tool in a Nigerian hospital and concluded that it identified high‐risk malnourished children on admission and during their hospital stay 2 . The tool may help healthcare professionals to prioritise patients and potentially improve survival.…”

“…highest risk of mortality. Dahl et al evaluated the use of the tool in a Nigerian hos-pital and concluded that it identified high-risk malnourished children on admission and during their hospital stay 2. The tool may help healthcare professionals to prioritise patients and potentially improve survival.…”