Validity of clinical severity scores for respiratory syncytial virus: a systematic review

Abstract

Background Respiratory syncytial virus (RSV) is a widespread respiratory pathogen, and RSV-related acute lower respiratory tract infections are the most common cause of respiratory hospitalisation in children under two. Over the last two decades, a number of severity scores have been proposed to quantify disease severity for RSV in children yet there remains no overall consensus on the most clinically useful score. Methods We conducted a systematic review of English-language publications in peer-reviewed journals published since January 2000 assessing the validity of severity scores for children (≤24 months) with RSV and/or bronchiolitis, and identified the most promising scores. For included articles, (i) validity data were extracted, (ii) quality of reporting assessed using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis checklist, and (iii) quality assessed using the Prediction model study Risk Of Bias Assessment Tool. To guide the assessment of the validity data, standardised cut-offs were employed, and an explicit definition of what we required to determine a score was sufficiently validated. Results Our searches identified 8,541 results, of which 1,779 were excluded as duplicates. After title and abstract screening, 6,670 references were excluded. Following full-text screening & snowballing 32 articles, including 31 scores, were included. The most frequently assessed scores were the modified Tal score and Wang Bronchiolitis Severity Score; none of the scores were found to be sufficiently validated according to our definition. The reporting and/or design of all the included studies was poor. The best validated score was the BROSJOD score, and a number of other promising scores were identified. Conclusions No scores were found to be sufficiently validated. Further work is warranted to validate the existing scores, ideally in much larger datasets.

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