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Kumwenda M, Assies R, Snik I, Chatima G, Langton J, Chimalizeni Y, Romaine ST, van Woensel JB, Pallmann P, Carrol ED, Calis JC. Identifying critically ill children in Malawi: A modified qSOFA score for low-resource settings. PLOS Glob Public Health 2024; 4:e0002388. [PMID: 38271303 PMCID: PMC10810502 DOI: 10.1371/journal.pgph.0002388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
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.
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Affiliation(s)
- Mercy Kumwenda
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Paediatrics and Child Health, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Roxanne Assies
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Global Health and PICU, Amsterdam Institute for Global Health and Development and Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Global Health and Quality of Care, Amsterdam, the Netherlands
| | - Ilse Snik
- Department of Global Health and PICU, Amsterdam Institute for Global Health and Development and Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Gloria Chatima
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Josephine Langton
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Yamikani Chimalizeni
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Sam T. Romaine
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Job B.M. van Woensel
- Department of Global Health and PICU, Amsterdam Institute for Global Health and Development and Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Global Health and Quality of Care, Amsterdam, the Netherlands
| | - Philip Pallmann
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Enitan D. Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Job C.J. Calis
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Global Health and PICU, Amsterdam Institute for Global Health and Development and Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Global Health and Quality of Care, Amsterdam, the Netherlands
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