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.
Faculty of Medicine, Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
J Pediatr. 2020 Oct;225:182-192.e2. doi: 10.1016/j.jpeds.2020.05.016. Epub 2020 May 18.
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.
描述在中低收入国家开发或验证的用于预测住院儿童死亡或临床恶化事件的预后模型的性能。
医学图书管理员系统地检索了 EMBASE、Ovid Medline、Scopus、Cochrane 图书馆、EBSCO Global Health、LILACS、非洲医学索引、非洲期刊在线、非洲健康热线、Med-Carib 和全球医学索引（从 2000 年到 2019 年 10 月）。我们纳入了描述在中低收入国家开发或验证儿科预后模型用于预测住院儿童死亡或临床恶化事件的文献。我们独立地重复提取了纳入人群和模型预后性能的数据，并使用预测模型风险偏倚评估工具评估了风险偏倚。
在 41279 篇独特的文献中，我们纳入了 15 项研究，这些研究描述了 15 项用于预测死亡率的预后模型和 3 项用于预测临床恶化事件的模型。有 6 项模型在超过 1 个外部队列中得到了验证。Lambarene 器官功能障碍评分（0.85[0.77-0.92]）和儿童炎症标志（0.85[0.82-0.88]）的综合 C 统计量（95% CI）最高，用于区分。校准和分类测量方法的报告较差。由于预测变量选择不当、处理缺失数据以及不完全报告性能测量方法，所有模型都存在较高的偏倚风险。
有几个用于预测死亡和临床恶化事件的预后模型已在单队列中得到验证，具有良好的区分能力。在临床实施之前，需要进行符合当前预测模型研究标准的严格验证，并更新现有模型。
