Abstract

External validation of an admission risk score for predicting inpatient paediatric mortality in two Kenyan public hospitals

Kamau S, Kigo J, Maina M, Gachohi J
Wellcome Open Res. 2024;9

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BACKGROUND: Early identification of children at risk of mortality during hospitalization is crucial in preventing mortality in low-and middle-income countries (LMICs). This study aimed to externally validate an admission risk score for predicting inpatient paediatric mortality in resource-limited settings. METHODS: This retrospective study utilized routine clinical data of children aged ≤12 years admitted to two Kenyan public hospitals between January 2017 and October 2023. The admission risk score includes 13 clinical predictors, each assigned a value. Aggregate values were used to predict inpatient pediatric mortality, with a higher score indicating a greater risk of death. Children with scores of 0, 1-4 and ≥5 were categorized as low, moderate and high-risk categories, respectively. Discrimination was assessed using area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative predictive values were calculated at different cutoff points. RESULTS: A total of 15,606 children were included in the study. Majority of the participants were male (8,847, 56.7%) and aged 12 - 59 months (7,222, 46.3%). Children classified as high-risk had a higher mortality rate (23.4%) than those classified as low risk (2%). The risk score demonstrated moderate discrimination, with an AUC of 0.73 (95% confidence interval (CI): 0.71 - 0.75). A cutoff of ≥3 achieved a balance between sensitivity and specificity, with values of 63.8% (95% CI: 60.7%-66.9%) and 72.2% (95% CI: 71.5% - 72.9%), respectively, compared to other cutoff points. CONCLUSION: The risk score performed moderately in predicting inpatient paediatric mortality in two Kenyan public hospitals. The risk score can be used with other clinical assessments to rapidly identify high-risk children and guide targeted interventions to prevent mortality.Identifying children at high risk of mortality during hospitalization is essential, especially in low- and middle-income countries. Healthcare providers can utilize risk assessment tools to evaluate and identify paediatric patients at elevated risk of mortality upon admission to hospital wards. These risk stratification scores are valuable tools that integrate clinical examination findings, medical history data, and/or laboratory results to estimate the probability of specific outcomes, such as hospital admission, clinical deterioration, or death. These tools enable healthcare workers to prioritize high-risk patients and implement timely, life-saving interventions, thereby reducing morbidity and mortality rates. In this study, we evaluated the performance of an admission risk score in predicting mortality among paediatric patients aged 12 years and below admitted to two public hospitals in Kenya. The risk assessment score demonstrated moderate ability in differentiating between children who survived and those who died during hospitalization. This risk stratification score can be employed in conjunction with other clinical assessments to prioritize care for paediatric patients at high risk of in-hospital mortality, potentially improving patient outcomes and resource allocation in resource-constrained settings.eng