Kumwenda, Mercy, Assies, Roxanne, Snik, Ilse, Chatima, Gloria, Langton, Josephine, Chimalizeni, Yamikani, Romaine, Sam T, van Woensel, Job BM, Pallmann, Philip, Carrol, Enitan D 
ORCID: 0000-0001-8357-7726 et al (show 1 more authors)
(2024)
Identifying critically ill children in Malawi: A modified qSOFA score for low-resource settings.
PLOS global public health, 4 (1).
e0002388-e0002388.
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Identifying critically ill children in Malawi A modified qSOFA score for low-resource settings.pdf - Open Access published version Download (1MB) | Preview |
Abstract
In low-resource settings, a reliable bedside score for timely identification of 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 United Kingdom cohorts. A similarly quick clinical assessment-only score has however not yet been developed for paediatric populations in sub-Saharan Africa. In a development cohort of critically ill children in Malawi, we calculated the 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 score (FEAST-PET). Prognostic performance for mortality was evaluated using area under the receiver operating characteristic curve (AUC). Mortality was 15.4% in the development (N = 493) and 22.0% in the validation cohort (N = 377). In the development 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 development cohort, and 0.74 (95%-CI:0.68-0.79) and 0.76 (95%-CI:0.70-0.82) in the validation cohort, respectively. We developed a simple prognostic score for Malawian children based on four clinical parameters which performed as well as a more complex score. 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: | Article |
|---|---|
| Uncontrolled Keywords: | Clinical Research, 4.2 Evaluation of markers and technologies, 4 Detection, screening and diagnosis, 3 Good Health and Well Being |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 05 Feb 2024 08:53 |
| Last Modified: | 17 Mar 2024 07:20 |
| DOI: | 10.1371/journal.pgph.0002388 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3178375 |
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