External validation of paediatric pneumonia and bronchiolitis risk scores to predict mortality in children hospitalised in Kenya: a retrospective cohort study

Abstract

Background: Acute lower respiratory tract infections (ALRIs) are a leading cause of pediatric mortality in low- and middle-income countries. In recent years, substantial research has been done to enhance risk stratification of children presenting with ALRIs, in a bid to improve health outcomes in resource-limited settings. We sought to analyze the performance of several pediatric ALRI risk scores in the prediction of mortality among children hospitalized with ALRIs in Kenya.

Methods: We retrospectively analyzed the data of 2182 children aged 2-24 months who were admitted to Kilifi County Referral Hospital, Kenya with severe ALRIs between January 2015 and December 2024. We evaluated the performance of 6 ALRI risk scores (RISC [HIV-negative], mRISC, RISC-Malawi, PERCH, PREPARE, and ReSVinet) in this population. Additionally, we created and evaluated a modified version of the ReSVinet score by including nutrition status. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC).

Results: The mid-upper arm circumference (MUAC) version of the RISC-Malawi score showed the highest discrimination for the outcome of in-hospital mortality (AUROC, 0.83; 95% confidence interval, .79-.86), whilst all other scores showed acceptable discrimination (AUROC, 0.70-0.79). The modification of ReSVinet to include nutrition status significantly improved its AUROC from 0.72 to 0.79.

Conclusions: All risk scores showed at least fair performance in the prediction of in-hospital mortality within our dataset. The RISC-Malawi (MUAC) score appears to be the most promising candidate for future implementation; however, further research is needed to evaluate the calibration, feasibility, and clinical utility of these scores.