Derivation and validation of a novel risk assessment tool to identify children aged 2-59 months at risk of hospitalised pneumonia-related mortality in 20 countries

• Type of Material: Article
• Authors: Christopher Rees, Emory University; Tim Colbourn, University College London; Shubhada Hooli, Texas Childrens Hospital; Carina King, Karolinska Institutet; Norman Lufesi, Government of Malawi Ministry of Health; Eric D McCollum, Johns Hopkins Sch Med; Charles Mwansambo, Government of Malawi Ministry of Health; Clare Cutland, University of Witwatersrand; Shabir A Madhi, University of Witwatersrand; Marta Nunes, University of Witwatersrand; Jospeh L Matthew, Postgraduate Institute of Medical Education and Research; Emmanuel Addo-Yobo, Komfo Anokye Teaching Hospital; Noel Chisaka, The World Bank; Mumtaz Hassan, Children’s Hospital; Patricia L Hibberd, Boston University; Prakash M Jeena, University of Kwazulu Natal; Juan M Lozano, Florida International University; William B MacLeod, Boston University; Archana Patel, Nagpur and Datta Meghe Institute of Medical Sciences; Donald M Thea, Boston University; Ngoc Tuong Vy Nguyen, Children Hospital 1; Cissy B Kartasasmita, Universitas Padjadjaran; Marilla Lucero, Res Inst Trop Med; Shally Awasthi, King George's Medical University; Ashish Bavdekar, KEM Hospital Pune; Monidarin Chou, University of Health Sciences, Cambodia; Pagbajabyn Nymadawa, Mongolian Academy of Sciences; Jean-William Pape, GHESKIO; Glaucia Paranhos-Baccala, Fondation Merieux, Lyon; Valentina S Picot, Fondation Merieux; Mala Rakoto-Andrianarivelo, Charles Merieux; Vanessa Rouzier, GHESKIO; Graciela Russomando, Instituto de Investigaciones en Ciencias de la Salud; Mariam Sylla, Gabriel Touré University Hospital Center; Philippe Vanhems, Hospices Civils de Lyon; Jianwei Wang, Chinese Academy of Medical Sciences & Peking Union; Rai Asghar, Rawalpindi Medical College; Salem Banajeh, Sana’a University; Imran Iqbal, Nishtar Medical College; Irene Maulen-Radovan, Instituto Nactional de Pediatria; Greta Mino-Leon, Children's Hospital Dr Francisco de Ycaza Bustamante; Samir K Saha, Dhaka Shishu Hospital; Mathuram Santosham, Johns Hopkins University; Sunit Singhi, Medanta; Sudha Basnet, Tribhuvan University Institute of Medicine; Tor A Strand, Innlandet Hospital Trust; Shinjin Bhatnagar, Translational Health Science and Technology Institute; Nitya Wadhwa, Translational Health Science and Technology Institute; Rakesh Lodha, All India Institute of Medical Sciences; Satinder Aneja, Sharda University; Alexey W Clara, Centers for Disease Control and Prevention, Atlanta; Harry Campbell, University of Edinburgh; Harish Nair, University of Edinburgh; Jennifer Falconer, University of Edinburgh; Shamim A Qazi, World Health Organization; Yasir B Nisar, World Health Organization; Mark Neuman, Harvard Medical School
• Language: English
• Date: 2022-04-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjgh-2021-008143
• Title of Journal or Parent Work: BMJ GLOBAL HEALTH
• Volume: 7
• Issue: 4
• Grant/Funding Information: This study was funded by the Bill & Melinda Gates Foundation (#INV-007927) through a grant to the WHO to SQ. The funders had no role in the study design or in the collection, analysis or interpretation of the data. The funders did not write the report and had no role in the decision to submit the paper for publication.
• Keywords: PNEUMOCOCCAL CONJUGATE VACCINE; MANAGEMENT; Life Sciences & Biomedicine; ZINC; Paediatrics; MODELS; Public, Environmental & Occupational Health; Science & Technology; Pneumonia; RANDOMIZED CONTROLLED-TRIAL
• Research Categories: Health Sciences, Pathology; Health Sciences, Medicine and Surgery

Abstract

Introduction Existing risk assessment tools to identify children at risk of hospitalised pneumonia-related mortality have shown suboptimal discriminatory value during external validation. Our objective was to derive and validate a novel risk assessment tool to identify children aged 2-59 months at risk of hospitalised pneumonia-related mortality across various settings. Methods We used primary, baseline, patient-level data from 11 studies, including children evaluated for pneumonia in 20 low-income and middle-income countries. Patients with complete data were included in a logistic regression model to assess the association of candidate variables with the outcome hospitalised pneumonia-related mortality. Adjusted log coefficients were calculated for each candidate variable and assigned weighted points to derive the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) risk assessment tool. We used bootstrapped selection with 200 repetitions to internally validate the PREPARE risk assessment tool. Results A total of 27 388 children were included in the analysis (mean age 14.0 months, pneumonia-related case fatality ratio 3.1%). The PREPARE risk assessment tool included patient age, sex, weight-for-age z-score, body temperature, respiratory rate, unconsciousness or decreased level of consciousness, convulsions, cyanosis and hypoxaemia at baseline. The PREPARE risk assessment tool had good discriminatory value when internally validated (area under the curve 0.83, 95% CI 0.81 to 0.84). Conclusions The PREPARE risk assessment tool had good discriminatory ability for identifying children at risk of hospitalised pneumonia-related mortality in a large, geographically diverse dataset. After external validation, this tool may be implemented in various settings to identify children at risk of hospitalised pneumonia-related mortality.