Development of the Respiratory Index of Severity in Children (RISC) Score among Young Children with Respiratory Infections in South Africa

Abstract

ObjectivePneumonia is a leading cause of death in children worldwide. A simple clinical score predicting the probability of death in a young child with lower respiratory tract infection (LRTI) could aid clinicians in case management and provide a standardized severity measure during epidemiologic studies.MethodsWe analyzed 4,148 LRTI hospitalizations in children <24 months enrolled in a pneumococcal conjugate vaccine trial in South Africa from 1998–2001, to develop the Respiratory Index of Severity in Children (RISC). Using clinical data at admission, a multivariable logistic regression model for mortality was developed and statistically evaluated using bootstrap resampling techniques. Points were assigned to risk factors based on their coefficients in the multivariable model. A child's RISC score is the sum of points for each risk factor present. Separate models were developed for HIV-infected and non-infected children.ResultsSignificant risk factors for HIV-infected and non-infected children included low oxygen saturation, chest indrawing, wheezing, and refusal to feed. The models also included age and HIV clinical classification (for HIV-infected children) or weight-for-age (for non-infected children). RISC scores ranged up to 7 points for HIV-infected or 6 points for non-infected children and correlated with probability of death (0–47%, HIV-infected; 0–14%, non-infected). Final models showed good discrimination (area under the ROC curve) and calibration (goodness-of-fit).ConclusionThe RISC score incorporates a simple set of risk factors that accurately discriminate between young children based on their risk of death from LRTI, and may provide an objective means to quantify severity based on the risk of mortality.

Predicting Severe Pneumonia Outcomes in Children

“…18,19 To allow for nonlinear associations, continuous predictors were modeled by using restricted cubic spline transformations. To account for known age-based differences in normal heart rate, respiratory rate, and blood pressure, interaction terms between each of these variables and age were included.…”

“…To inform care decisions and optimize outcomes, the 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America childhood pneumonia management guidelines emphasized the need for objective risk-stratification tools. 15 Reed et al 19 previously developed a simple tool to predict in-hospital pneumonia mortality in young South African children, although its utility in settings in which pediatric pneumonia mortality is rare has not been evaluated. Our prognostic models focused on in-hospital outcomes and evaluated an expanded set of predictors routinely collected for clinical care.…”

Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings

“…Currently, identification of these IMCI symptoms remains inconsistent and unreliable among community health-care workers or carers without clinical training 7 . Therefore, improved prognostic and diagnostic tools for case-management are necessary to substantially reduce pneumonia-associated morbidity and mortality.Hypoxaemia and malnutrition are strong predictors of mortality in children who are hospitalized for pneumonia 8,9 . This has led to increasing support for the use of oxygen therapy and monitoring oxygen saturation in the management of severe cases.…”

“…Hypoxaemia and malnutrition are strong predictors of mortality in children who are hospitalized for pneumonia 8,9 . This has led to increasing support for the use of oxygen therapy and monitoring oxygen saturation in the management of severe cases.…”

Skor Prediksi Kematian Pneumonia pada Anak Usia di Bawah Lima Tahun

“…15 Sistem skor serupa telah dikembangkan di Afrika Selatan, yaitu the respiratory index of severity in children score (RISC). 16 Sistem skor tersebut mempunyai tujuan yang sama, yaitu untuk memprediksi kematian pada anak usia muda dengan infeksi saluran pernapasan bawah, tetapi variabel yang dimasukkan dalam sistem skor ini berbeda. Variabel yang dievaluasi dalam RISC meliputi saturasi oksigen yang rendah (skor=3), retraksi dinding dada (skor=2), mengi (skor=-2), menolak makan (skor=1), berat badan sesuai usia dengan z score: z <-3 (skor=2), -2 < z <-3 (skor=1), z >-2 (skor=0).…”