Independent Validation of an Existing Model Enables Prediction of Hearing Loss after Childhood Bacterial Meningitis
Open Access
- 11 March 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (3), e58707
- https://doi.org/10.1371/journal.pone.0058707
Abstract
This study aimed external validation of a formerly developed prediction model identifying children at risk for hearing loss after bacterial meningitis (BM). Independent risk factors included in the model are: duration of symptoms prior to admission, petechiae, cerebral spinal fluid (CSF) glucose level, Streptococcus pneumoniae and ataxia. Validation helps to evaluate whether the model has potential in clinical practice. 116 Dutch school-age BM survivors were included in the validation cohort and screened for sensorineural hearing loss (>25 dB). Risk factors were obtained from medical records. The model was applied to the validation cohort and its performance was compared with the development cohort. Validation was performed by application of the model on the validation cohort and by assessment of discrimination and goodness of fit. Calibration was evaluated by testing deviations in intercept and slope. Multiple imputation techniques were used to deal with missing values. Risk factors were distributed equally between both cohorts. Discriminative ability (Area Under the Curve, AUC) of the model was 0.84 in the development and 0.78 in the validation cohort. Hosmer-Lemeshow test for goodness of fit was not significant in the validation cohort, implying good fit concerning the similarity of expected and observed cases. There were no significant differences in calibration slope and intercept. Sensitivity and negative predicted value were high, while specificity and positive predicted value were low which is comparable with findings in the development cohort. Performance of the model remained good in the validation cohort. This prediction model might be used as a screening tool and can help to identify those children that need special attention and a long follow-up period or more frequent auditory testing.Keywords
This publication has 41 references indexed in Scilit:
- Polymorphisms in Toll-Like Receptors 2, 4, and 9 Are Highly Associated with Hearing Loss in Survivors of Bacterial MeningitisPLOS ONE, 2012
- Clinical Prediction Rules for Children: A Systematic ReviewPediatrics, 2011
- Dutch Cochlear Implant Group (CI-ON) Consensus Protocol on Postmeningitis Hearing Evaluation and TreatmentOtology & Neurotology, 2010
- Simulated effect of pneumococcal vaccination in the Netherlands on existing rules constructed in a non-vaccinated cohort predicting sequelae after bacterial meningitisBMC Infectious Diseases, 2010
- Effects of Pneumococcal Conjugate Vaccine 2 Years after Its Introduction, the NetherlandsEmerging Infectious Diseases, 2010
- Combining estimates of interest in prognostic modelling studies after multiple imputation: current practice and guidelinesBMC Medical Research Methodology, 2009
- Dealing with Missing Predictor Values When Applying Clinical Prediction ModelsClinical Chemistry, 2009
- Advantages of the nested case-control design in diagnostic researchBMC Medical Research Methodology, 2008
- Review: A gentle introduction to imputation of missing valuesJournal of Clinical Epidemiology, 2006
- Hearing impairment in children after bacterial meningitis: Incidence and resource implicationsBritish Journal of Audiology, 1993