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Performance of Pediatric Mortality Prediction Models in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

Authors
  • Muttalib, Fiona1
  • Clavel, Virginie2
  • Yaeger, Lauren H3
  • Shah, Vibhuti4
  • Adhikari, Neill K J5
  • 1 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Center for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: [email protected] , (Canada)
  • 2 Faculty of Medicine, Department of Pediatrics, McGill University, Montreal, Quebec, Canada. , (Canada)
  • 3 Becker Medical Library Washington University School of Medicine in St. Louis, St. Louis, MO.
  • 4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada. , (Canada)
  • 5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. , (Canada)
Type
Published Article
Journal
The Journal of pediatrics
Publication Date
Oct 01, 2020
Volume
225
Identifiers
DOI: 10.1016/j.jpeds.2020.05.016
PMID: 32439313
Source
Medline
Language
English
License
Unknown

Abstract

To describe the performance of prognostic models for mortality or clinical deterioration events among hospitalized children developed or validated in low- and middle-income countries. A medical librarian systematically searched EMBASE, Ovid Medline, Scopus, Cochrane Library, EBSCO Global Health, LILACS, African Index Medicus, African Journals Online, African Healthline, Med-Carib, and Global Index Medicus (from 2000 to October 2019). We included citations that described the development or validation of a pediatric prognostic model for hospital mortality or clinical deterioration events in low- and middle-income countries. In duplicate and independently, we extracted data on included populations and model prognostic performance and evaluated risk of bias using the Prediction model Risk Of Bias Assessment Tool. Of 41 279 unique citations, we included 15 studies describing 15 prognostic models for mortality and 3 models for clinical deterioration events. Six models were validated in >1 external cohort. The Lambarene Organ Dysfunction Score (0.85 [0.77-0.92]) and Signs of Inflammation in Children that Kill (0.85 [0.82-0.88]) had the highest summary C-statistics (95% CI) for discrimination. Calibration and classification measures were poorly reported. All models were at high risk of bias owing to inappropriate selection of predictor variables and handling of missing data and incomplete performance measure reporting. Several prognostic models for mortality and clinical deterioration events have been validated in single cohorts, with good discrimination. Rigorous validation that conforms to current standards for prediction model studies and updating of existing models are needed before clinical implementation. Copyright © 2020 Elsevier Inc. All rights reserved.

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