title: Independent validation of an existing model enables prediction of hearing loss after childhood bacterial meningitis.
abstract: OBJECTIVE
  This study aimed external validation of a formerly developed prediction model identifying children at risk for hearing loss after bacterial meningitis (BM). Independent risk factors included in the model are: duration of symptoms prior to admission, petechiae, cerebral spinal fluid (CSF) glucose level, Streptococcus pneumoniae and ataxia. Validation helps to evaluate whether the model has potential in clinical practice.
  
  
  METHODS
  116 Dutch school-age BM survivors were included in the validation cohort and screened for sensorineural hearing loss (>25 dB). Risk factors were obtained from medical records. The model was applied to the validation cohort and its performance was compared with the development cohort. Validation was performed by application of the model on the validation cohort and by assessment of discrimination and goodness of fit. Calibration was evaluated by testing deviations in intercept and slope. Multiple imputation techniques were used to deal with missing values.
  
  
  RESULTS
  Risk factors were distributed equally between both cohorts. Discriminative ability (Area Under the Curve, AUC) of the model was 0.84 in the development and 0.78 in the validation cohort. Hosmer-Lemeshow test for goodness of fit was not significant in the validation cohort, implying good fit concerning the similarity of expected and observed cases. There were no significant differences in calibration slope and intercept. Sensitivity and negative predicted value were high, while specificity and positive predicted value were low which is comparable with findings in the development cohort.
  
  
  CONCLUSIONS
  Performance of the model remained good in the validation cohort. This prediction model might be used as a screening tool and can help to identify those children that need special attention and a long follow-up period or more frequent auditory testing.
authors.affiliation: Department of Pediatric Infectious Diseases - Immunology, and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands. r.c.j.dejonge@erasmusmc.nl
authors.forename: Rogier C J
authors.initials: RC
authors.lastname: de Jonge
authors.forename: Marieke S
authors.initials: MS
authors.lastname: Sanders
authors.forename: Caroline B
authors.initials: CB
authors.lastname: Terwee
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
authors.forename: Reinoud J B J
authors.initials: RJ
authors.lastname: Gemke
authors.forename: Irene
authors.initials: I
authors.lastname: Koomen
authors.forename: Lodewijk
authors.initials: L
authors.lastname: Spanjaard
authors.forename: A Marceline
authors.initials: AM
authors.lastname: van Furth
mesh_terms: D002675:Child, Preschool; D005260:Female; D034381:Hearing Loss / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
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