title: Pediatric in-Hospital Death from Infectious Disease in Uganda: Derivation of Clinical Prediction Models.
abstract: BACKGROUND
  Pediatric hospital mortality from infectious diseases in resource constrained countries remains unacceptably high. Improved methods of risk-stratification can assist in referral decision making and resource allocation. The purpose of this study was to create prediction models for in-hospital mortality among children admitted with suspected infectious diseases.
  
  
  METHODS
  This two-site prospective observational study enrolled children between 6 months and 5 years admitted with a proven or suspected infection. Baseline clinical and laboratory variables were collected on enrolled children. The primary outcome was death during admission. Stepwise logistic regression minimizing Akaike's information criterion was used to identify the most promising multivariate models. The final model was chosen based on parsimony.
  
  
  RESULTS
  1307 children were enrolled consecutively, and 65 (5%) of whom died during their admission. Malaria, pneumonia and gastroenteritis were diagnosed in 50%, 31% and 8% of children, respectively. The primary model included an abnormal Blantyre coma scale, HIV and weight-for-age z-score. This model had an area under the curve (AUC) of 0.85 (95% CI, 0.80-0.89) with a sensitivity and specificity of 83% and 76%, respectively. The positive and negative predictive values were 15% and 99%, respectively. Two alternate models with similar performance characteristics were developed withholding HIV and weight-for-age z-score, for use when these variables are not available.
  
  
  CONCLUSIONS
  Risk stratification of children admitted with infectious diseases can be calculated based on several easily measured variables. Risk stratification at admission can be used for allocation of scarce human and physical resources and to guide referral among children admitted to lower level health facilities.
authors.affiliation: Department of Anesthesiology, Pharmacology, & Therapeutics, University of British Columbia, Vancouver, Canada.
authors.forename: Nasim
authors.initials: N
authors.lastname: Lowlaavar
authors.affiliation: Center for International Child Health, BC Children's Hospital, Child and Family Research Institute, Vancouver, Canada.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Larson
authors.affiliation: Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Elias
authors.initials: E
authors.lastname: Kumbakumba
authors.affiliation: Department of Statistics, University of British Columbia, Vancouver, Canada.
authors.forename: Guohai
authors.initials: G
authors.lastname: Zhou
authors.affiliation: Department of Anesthesiology, Pharmacology, & Therapeutics, University of British Columbia, Vancouver, Canada.
authors.forename: J Mark
authors.initials: JM
authors.lastname: Ansermino
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.|Canadian HIV Trials Network, St. Paul's Hospital and University of British Columbia, Vancouver, Canada.
authors.forename: Joel
authors.initials: J
authors.lastname: Singer
authors.affiliation: Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, Canada.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Kissoon
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Hubert
authors.initials: H
authors.lastname: Wong
authors.affiliation: Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ndamira
authors.affiliation: Maternal, Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Jerome
authors.initials: J
authors.lastname: Kabakyenga
authors.affiliation: Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Julius
authors.initials: J
authors.lastname: Kiwanuka
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Wiens
mesh_terms: D002675:Child, Preschool; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis / Q000401:mortality*; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008954:Models, Biological; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality*; D011237:Predictive Value of Tests; D014454:Uganda / Q000453:epidemiology