title: Unsuccessful validation of 2004 model for predicting academic or behavioural limitations after childhood bacterial meningitis.
abstract: OBJECTIVE
  In 2004, a model identifying children at risk of academic or behavioural limitations after bacterial meningitis (BM) was presented. Risk factors were male gender, low birthweight, lower educational level of the father, Streptococcus pneumoniae, lower cerebrospinal fluid (CSF) leucocyte count, delay between admission and start of antibiotics, dexamethasone <2 days, seizures and prolonged fever. The aim of this study was to validate that prediction model in an independent cohort.
  
  
  METHODS
  Academic or behavioural limitations were determined in 93 Dutch school-age BM survivors. Risk factors for limitations were obtained from medical files. Validation was performed by applying the model in the cohort, then assessing discrimination and goodness of fit. Multiple imputation techniques were used to deal with missing values.
  
  
  RESULTS
  Although fit of the model appeared good when it came to similarity of expected and observed cases (p-value of the Hosmer-Lemeshow test 0.24-0.57), discrimination was poor. Area under the curve (AUC) of the receiver operated characteristics (ROC) curve of the model was 0.83 (95% CI: 0.77-0.89) in the development cohort and 0.53 (95% CI: 0.41-0.65) in the validation cohort.
  
  
  CONCLUSIONS
  External validation of the model was unsuccessful. It is not suitable for implementation in practice.
authors.affiliation: Department of Paediatric Infectious Diseases - Immunology and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Department of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. r.c.j.dejonge@erasmusmc.nl.
authors.forename: R C J
authors.initials: RC
authors.lastname: de Jonge
authors.forename: M S
authors.initials: MS
authors.lastname: Sanders
authors.forename: C B
authors.initials: CB
authors.lastname: Terwee
authors.forename: M W
authors.initials: MW
authors.lastname: Heymans
authors.forename: R J B J
authors.initials: RJ
authors.lastname: Gemke
authors.forename: I
authors.initials: I
authors.lastname: Koomen
authors.forename: L
authors.initials: L
authors.lastname: Spanjaard
authors.forename: A M
authors.initials: AM
authors.lastname: van Furth
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002652:Child Behavior; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000209:etiology*; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000523:psychology; D008962:Models, Theoretical; D009426:Netherlands
keywords: Academic or behavioural limitations; Childhood bacterial meningitis; External validation; Prediction model; Sequelae