title: Predicting mortality among hospitalized children with respiratory illness in Western Kenya, 2009-2012.
abstract: BACKGROUND
  Pediatric respiratory disease is a major cause of morbidity and mortality in the developing world. We evaluated a modified respiratory index of severity in children (mRISC) scoring system as a standard tool to identify children at greater risk of death from respiratory illness in Kenya.
  
  
  METHODS
  We analyzed data from children <5 years old who were hospitalized with respiratory illness at Siaya District Hospital from 2009-2012. We used a multivariable logistic regression model to identify patient characteristics predictive for in-hospital mortality. Model discrimination was evaluated using the concordance statistic. Using bootstrap samples, we re-estimated the coefficients and the optimism of the model. The mRISC score for each child was developed by adding up the points assigned to each factor associated with mortality based on the coefficients in the multivariable model.
  
  
  RESULTS
  We analyzed data from 3,581 children hospitalized with respiratory illness; including 218 (6%) who died. Low weight-for-age [adjusted odds ratio (aOR) = 2.1; 95% CI 1.3-3.2], very low weight-for-age (aOR = 3.8; 95% CI 2.7-5.4), caretaker-reported history of unconsciousness (aOR = 2.3; 95% CI 1.6-3.4), inability to drink or breastfeed (aOR = 1.8; 95% CI 1.2-2.8), chest wall in-drawing (aOR = 2.2; 95% CI 1.5-3.1), and being not fully conscious on physical exam (aOR = 8.0; 95% CI 5.1-12.6) were independently associated with mortality. The positive predictive value for mortality increased with increasing mRISC scores.
  
  
  CONCLUSIONS
  A modified RISC scoring system based on a set of easily measurable clinical features at admission was able to identify children at greater risk of death from respiratory illness in Kenya.
authors.affiliation: Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya.
authors.forename: Gideon O
authors.initials: GO
authors.lastname: Emukule
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Meredith
authors.initials: M
authors.lastname: McMorrow
authors.affiliation: Stanford University School of Medicine, Stanford, California, United States of America.
authors.forename: Chulie
authors.initials: C
authors.lastname: Ulloa
authors.affiliation: Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya.
authors.forename: Sammy
authors.initials: S
authors.lastname: Khagayi
authors.affiliation: Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya.
authors.forename: Henry N
authors.initials: HN
authors.lastname: Njuguna
authors.affiliation: Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya.
authors.forename: Deron
authors.initials: D
authors.lastname: Burton
authors.affiliation: Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Montgomery
authors.affiliation: Ministry of Public Health and Sanitation, Division of Disease Surveillance and Response, Nairobi, Kenya.
authors.forename: Philip
authors.initials: P
authors.lastname: Muthoka
authors.affiliation: Centers for Disease Control and Prevention, Port-au-Prince, Haiti.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Katz
authors.affiliation: Emory University, Atlanta, Georgia, United States of America.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.affiliation: Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Mott
mesh_terms: D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D008297:Male; D015233:Models, Statistical; D009017:Morbidity; D012372:ROC Curve; D012017:Referral and Consultation; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012720:Severity of Illness Index