Identifying critically ill children at risk of dying during hospital admission in Malawi: prognostic accuracy of a modified qSOFA score for low-resource settings

Kumwenda, Mercy, Assies, Roxanne, Snik, Ilse, Chathima, G., Langton, J., Chimalizeni, Y., Romaine, Sam T., van Woensel, J.B., Pallmann, Philip ORCID: https://orcid.org/0000-0001-8274-9696, Carrol, Enitan D. and Calis, J.C. 2022. Identifying critically ill children at risk of dying during hospital admission in Malawi: prognostic accuracy of a modified qSOFA score for low-resource settings. Presented at: 11th World Congress on Pediatric Intensive and Critical Care, Virtual, 12-16 July 2022. Pediatric Critical Care Medicine. , vol.23 (OP044) 10.1097/01.pcc.0000899856.14238.94

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Abstract

BACKGROUND AND AIM: In low-resource settings, a reliable bedside score to identify children at risk of dying could help focus resources and improve survival. The rapid bedside Liverpool quick sequential organ failure assessment (LqSOFA) uses clinical parameters only and performed well in the UK, but has not been validated in a low-resource setting. METHOD: In a cohort of critically ill children in Malawi, we calculated LqSOFA-scores using age-adjusted heart rate and respiratory rate, capillary refill time and Blantyre Coma Scale and evaluated its prognostic performance for mortality. An improved score, the Blantyre qSOFA (BqSOFA), was developed (omitting heart rate, adjusting respiratory rate cut-off values and adding pallor), subsequently validated in a second cohort of Malawian children, and compared with an existing more complex score (FEAST-PET). Prognostic performance for mortality was evaluated using area under the receiver operating characteristic curve (AUC). RESULTS: Mortality was 15.4% in the derivation (n=493) and 22.0% in the validation cohort (n=377). In the derivation cohort, discriminative ability (AUC) of the LqSOFA to predict mortality was 0.68 (95%-CI: 0.60-0.76). The BqSOFA and FEAST-PET yielded AUCs of 0.84 (95%-CI: 0.79-0.89) and 0.83 (95%-CI: 0.77-0.89) in the derivation cohort, and 0.74 (95%-CI: 0.68-0.79) and 0.76 (95%-CI: 0.70-0.82) in the validation cohort, respectively. CONCLUSIONS: We developed a simple prognostic score for Malawian children based on four clinical parameters which performed as well as more complex scores. The BqSOFA might be used to promptly identify critically ill children at risk of dying and prioritize hospital care in low-resource settings.

Item Type:	Conference or Workshop Item (Paper)
Date Type:	Publication
Status:	Published
Schools:	Centre for Trials Research (CNTRR)
Additional Information:	Oral Abstract
ISSN:	1529-7535
Last Modified:	26 Jan 2023 12:30
URI:	https://orca.cardiff.ac.uk/id/eprint/153998

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