Department of Pediatrics, King George's Medical University, Shah Mina Road, Lucknow, Uttar Pradesh-226003, India.
Bull World Health Organ. 2023 Apr 1;101(4):281-289. doi: 10.2471/BLT.22.289000. Epub 2023 Feb 21.
To externally validate a tool developed by the Pneumonia Research Partnership to Assess WHO Recommendations study group for identification of the risk of death in children hospitalized with community-acquired pneumonia, the PREPARE tool.
We did a secondary analysis of data collected during hospital-based surveillance of children with community-acquired pneumonia in northern India from January 2015 to February 2022. We included children aged 2-59 months with pulse oximetry assessment. We used multivariable backward stepwise logistic regression analysis to assess the strength of association of the PREPARE variables (except hypothermia) with pneumonia-related death. We estimated sensitivity, specificity, and positive and negative likelihood ratios of the PREPARE score at cut-off scores ≥ 3, ≥ 4 and ≥ 5.
Of 10 943 children screened, 6745 (61.6%) were included in our analysis, of whom 93 (1.4%) died. Age of < 1 year, female sex, weight-for-age < -3 standard deviations, respiratory rate of ≥ 20 breaths/min higher than the age-specific cut-off, and lethargy, convulsions, cyanosis and blood oxygen saturation < 90% were associated with death. In the validation, the PREPARE score had the highest sensitivity (79.6%) with concurrent highest specificity (72.5%) to identify hospitalized children at risk of death from community-acquired pneumonia at a cut-off score of ≥ 5. Area under curve was 0.82 (95% confidence interval: 0.77-0.86).
The PREPARE tool with pulse oximetry showed good discriminatory ability on external validation in northern India. The tool can be used to assess risk of death of hospitalized children aged 2-59 months with community-acquired pneumonia for early referral to higher-level facilities.
验证肺炎研究伙伴关系为评估世界卫生组织推荐的工具开发的工具，用于识别因社区获得性肺炎住院的儿童死亡风险，该工具为 PREPARE 工具。
我们对 2015 年 1 月至 2022 年 2 月期间在印度北部进行的社区获得性肺炎医院监测中收集的数据进行了二次分析。我们纳入了接受脉搏血氧测定评估的 2-59 个月龄儿童。我们使用多变量向后逐步逻辑回归分析评估了 PREPARE 变量（除低体温外）与肺炎相关死亡的关联强度。我们在截断分数≥3、≥4 和≥5 时，估计了 PREPARE 评分的敏感性、特异性、阳性和阴性似然比。
在筛查的 10943 名儿童中，6745 名（61.6%）被纳入我们的分析，其中 93 名（1.4%）死亡。年龄<1 岁、女性、体重低于年龄特定截断值的-3 个标准差以下、呼吸频率高于年龄特异性截断值的≥20 次/分钟、昏睡、抽搐、发绀和血氧饱和度<90%与死亡相关。在验证中，PREPARE 评分在截断分数≥5 时，具有最高的敏感性（79.6%），同时具有最高的特异性（72.5%），以识别患有社区获得性肺炎的住院儿童死亡风险。曲线下面积为 0.82（95%置信区间：0.77-0.86）。
在印度北部的外部验证中，带有脉搏血氧测定的 PREPARE 工具显示出良好的鉴别能力。该工具可用于评估 2-59 个月龄因社区获得性肺炎住院的儿童死亡风险，以便及早转至更高水平的医疗机构。
