Development and an initial validation of the Responses to Illness Severity Quantification (RISQ) score for severely malnourished children

Abstract

Aim: To develop and perform an initial validation of a score to measure the severity of illness in hospitalised children with severe acute malnutrition (SAM).

Methods: A prospective study enrolled SAM children aged 6-59 months hospitalised in Borno State, Nigeria. Candidate items associated with inpatient mortality were combined and evaluated as candidate scores. Clinical and statistical methods were used to identify a preferred score.

Results: The 513 children enrolled had a mean age of 15.6 months of whom 48 (9%) died. Seven of the 10 evaluated items were significantly associated with mortality. Five different candidate scores were tested. The final score, Responses to Illness Severity Quantification (RISQ), included seven items: heart rate, respiratory rate, respiratory effort, oxygen saturation, oxygen delivery, temperature and level of consciousness. The mean RISQ score on admission was 2.6 in hospital survivors and 7.3 for children dying <48 h. RISQ scores <24 h before death had an area under the receiver operating characteristic curve (AUROC) of 0.93. The RISQ score performed similarly across differing clinical conditions with AUROCs 0.77-0.98 for all conditions except oedema.

Conclusion: The RISQ score can identify high-risk malnourished children at and during hospital admission. Clinical application may help prioritise care and potentially improve survival.

Keywords: malnutrition; mortality; score; severity of illness.

Conflict of interest statement

C. Parshuram is the named inventor of the Bedside Paediatric Early Warning System and has shares in a Decision Support Company in part owned by the Hospital for Sick Children. Other authors declare no conflicts.

© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.

Figures

FIGURE 1

Box plot showing the distributions of candidate scores at admission by final outcome. The box extends between the upper and lower quartiles, the line in the box marks the position of the median and the lines on either sides of the box show the minimum and maximum values. HR, heart rate; RR, respiratory rate; O2 sat, oxygen saturation; O2, oxygen therapy; RE, respiratory effort; SBP, systolic blood pressure; CRT, capillary refill time. Candidate RISQ scores: All scores include these five core items: HR, RR, O2 Sat, O2 and RE. Additional items in each score are as follows: (A) Core + SBP + CRT; (B) Core alone; (C) Core + Temp; (D) Core + LOC; (E) Core + LOC + Temp