Development of the Respiratory Index of Severity in Children (RISC) Score among Young Children with Respiratory Infections in South Africa
Open Access
- 4 January 2012
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 7 (1), e27793
- https://doi.org/10.1371/journal.pone.0027793
Abstract
Pneumonia 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. We 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. Significant 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). The 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.Keywords
This publication has 29 references indexed in Scilit:
- Clinical signs that predict severe illness in children under age 2 months: a multicentre studyThe Lancet, 2008
- Ambulatory short-course high-dose oral amoxicillin for treatment of severe pneumonia in children: a randomised equivalency trialThe Lancet, 2008
- HIV-related pulmonary disorders: practice issuesPaediatrics and International Child Health, 2007
- Effect of age, polymicrobial disease, and maternal HIV status on treatment response and cause of severe pneumonia in South African children: a prospective descriptive studyThe Lancet, 2007
- Incidence of Opportunistic and Other Infections in HIV-Infected Children in the HAART EraJAMA, 2006
- Translating Clinical Research into Clinical Practice: Impact of Using Prediction Rules To Make DecisionsAnnals of Internal Medicine, 2006
- Usefulness of C-Reactive Protein to Define Pneumococcal Conjugate Vaccine Efficacy in the Prevention of PneumoniaThe Pediatric Infectious Disease Journal, 2006
- The Impact of a 9-Valent Pneumococcal Conjugate Vaccine on the Public Health Burden of Pneumonia in HIV-Infected and -Uninfected ChildrenClinical Infectious Diseases, 2005
- A Prediction Rule to Identify Low-Risk Patients with Community-Acquired PneumoniaThe New England Journal of Medicine, 1997
- MULTIVARIABLE PROGNOSTIC MODELS: ISSUES IN DEVELOPING MODELS, EVALUATING ASSUMPTIONS AND ADEQUACY, AND MEASURING AND REDUCING ERRORSStatistics in Medicine, 1996