In a systematic review of 1.5 million children in LMICs, the best performing risk prediction models were SICK for emergency departments, pSOFA and PEDIA for wards, and PELOD for intensive care.
Systematic Review (n=1,500,000)
Yes
Which risk prediction model best predicts clinical deterioration in children at different stages of hospital admission in low- and middle-income countries?
Specific risk prediction models like SICK, pSOFA, PEDIA, and PELOD perform best for predicting clinical deterioration in children in low- and middle-income countries, though current evidence is limited by high risk of bias.
OBJECTIVE: To determine which risk prediction model best predicts clinical deterioration in children at different stages of hospital admission in low- and middle-income countries. METHODS: For this systematic review, Embase and MEDLINE databases were searched, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The key search terms were "development or validation study with risk-prediction model" AND "deterioration or mortality" AND "age 0-18 years" AND "hospital-setting: emergency department (ED), pediatric ward (PW), or pediatric intensive care unit (PICU)" AND "low- and middle-income countries." The Prediction Model Risk of Bias Assessment Tool was used by two independent authors. Forest plots were used to plot area under the curve according to hospital setting. Risk prediction models used in two or more studies were included in a meta-analysis. RESULTS: We screened 9486 articles and selected 78 publications, including 67 unique predictive models comprising 1.5 million children. The best performing models individually were signs of inflammation in children that can kill (SICK) (ED), pediatric early warning signs resource limited settings (PEWS-RL) (PW), and Pediatric Index of Mortality (PIM) 3 as well as pediatric sequential organ failure assessment (pSOFA) (PICU). Best performing models after meta-analysis were SICK (ED), pSOFA and Pediatric Early Death Index for Africa (PEDIA)-immediate score (PW), and pediatric logistic organ dysfunction (PELOD) (PICU). There was a high risk of bias in all studies. CONCLUSIONS: We identified risk prediction models that best estimate deterioration, although these risk prediction models are not routinely used in low- and middle-income countries. Future studies should focus on large scale external validation with strict methodological criteria of multiple risk prediction models as well as study the barriers in the way of implementation. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews: Prospero ID: CRD42021210489.
Brink et al. (Sat,) conducted a systematic review in Clinical deterioration and mortality (n=1,500,000). Risk prediction models (e.g., SICK, PEWS-RL, PIM 3, pSOFA, PEDIA, PELOD) was evaluated on Prediction of clinical deterioration or mortality. In a systematic review of 1.5 million children in LMICs, the best performing risk prediction models were SICK for emergency departments, pSOFA and PEDIA for wards, and PELOD for intensive care.