Evaluating the Validity of the Responses to Illness Severity Quantification Score to Discriminate Illness Severity and Level of Care Transitions in Hospitalized Children with Severe Acute Malnutrition

Nancy M Dale; Garba Mohammed Ashir; Lawan Bukar Maryah; Susan Shepherd; George Tomlinson; André Briend; Stanley Zlotkin; Christopher S Parshuram

doi:10.1016/j.jpeds.2023.113609

Evaluating the Validity of the Responses to Illness Severity Quantification Score to Discriminate Illness Severity and Level of Care Transitions in Hospitalized Children with Severe Acute Malnutrition

J Pediatr. 2023 Nov:262:113609. doi: 10.1016/j.jpeds.2023.113609. Epub 2023 Jul 5.

Authors

Nancy M Dale¹, Garba Mohammed Ashir², Lawan Bukar Maryah², Susan Shepherd³, George Tomlinson⁴, André Briend⁵, Stanley Zlotkin⁶, Christopher S Parshuram⁷

Affiliations

¹ Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Center for Safety Research, Toronto, ON, Canada; Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland.
² Department of Pediatrics, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria.
³ Alliance for International Medical Action, Dakar, Senegal.
⁴ Department of Medicine, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada.
⁵ Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland; Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark.
⁶ Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
⁷ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Center for Safety Research, Toronto, ON, Canada; Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada. Electronic address: chris@sickkids.ca.

PMID: 37419241
DOI: 10.1016/j.jpeds.2023.113609

Abstract

Objective: To evaluate the validity of the Responses to Illness Severity Quantification (RISQ) score to discriminate illness severity and transitions between levels of care during hospitalization.

Study design: A prospective observational study conducted in Maiduguri, Nigeria, enrolled inpatients aged 1-59 months with severe acute malnutrition. The primary outcome was the RISQ score associated with the patient state. Heart and respiratory rate, oxygen saturation, respiratory effort, oxygen use, temperature, and level of consciousness are summed to calculate the RISQ score. Five states were defined by levels of care and hospital discharge outcome. The states were classified hierarchically, reflecting illness severity: hospital mortality was the most severe state, then intensive care unit (ICU), care in the stabilization phase (SP), care in the rehabilitation phase (RP), and lowest severity, survival at hospital discharge. A multistate statistical model examined performance of the RISQ score in predicting clinical states and transitions.

Results: Of 903 children enrolled (mean age, 14.6 months), 63 (7%) died. Mean RISQ scores during care in each phase were 3.5 (n = 2265) in the ICU, 1.7 (n = 6301) in the SP, and 1.5 (n = 2377) in the RP. Mean scores and HRs for a 3-point change in score at transitions: ICU to death, 6.9 (HR, 1.80); SP to ICU, 2.8 (HR, 2.00); ICU to SP, 2.0 (HR, 0.5); and RP to discharge, 1.4 (HR, 0.91).

Conclusions: The RISQ score can discriminate between points of escalation or de-escalation of care and reflects illness severity in hospitalized children with severe acute malnutrition. Evaluation of clinical implementation and demonstration of benefit will be important before widespread adoption.

Keywords: inpatient mortality; low-resource health systems; severe acute malnutrition; severity of illness.

Publication types

Observational Study

MeSH terms

Child
Child, Hospitalized*
Humans
Infant
Intensive Care Units
Nigeria
Patient Acuity
Patient Transfer
Severe Acute Malnutrition* / diagnosis
Severe Acute Malnutrition* / therapy
Severity of Illness Index