Journal
JOURNAL OF PEDIATRICS
Volume 232, Issue -, Pages 200-+Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jpeds.2020.12.077
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Funding
- Cumming School of Medicine-Alberta Health Services Clinical Research Fund
- Alberta Children's Hospital Foundation Professorship in Child Health and Wellness
- Administrative and Resource Access Core of the Washington University Digestive Diseases Research Core Center (National Institutes of health [NIH]) [P30DK052574]
- Agency for Healthcare Research and Quality [1K08 HS026503]
- University of Ottawa Research in Pediatric Emergency Medicine
- Canadian Institutes of Health Research Banting Postdoctoral Fellowship
- Alberta Innovates Health Programs Postgraduate Fellowship
- University of Calgary Eyes High Postdoctoral Fellowship
- Luminex Corporation
- Health Resources and Services Administration Washington, Boston, Chicago Network
- NIH-Emergency Department Probiotics
- BioMerieux
- NIH-RNA Biosignatures
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The HUS severity score showed acceptable discrimination in identifying high-risk children under 5 years old with STEC-associated HUS in a North American acute care setting, but did not demonstrate meaningful clinical benefit at a specific risk threshold.
Objective To assess the performance of a hemolytic uremic syndrome (HUS) severity score among children with Shiga toxin-producing Escherichia colt (STEC) infections and HUS by stratifying them according to their risk of adverse events. The score has not been previously evaluated in a North American acute care setting. Study design We reviewed medical records of children <18 years old infected with STEC and treated in 1 of 38 participating emergency departments in North America between 2011 and 2015. The HUS severity score (hemoglobin [g/dL] plus 2-times serum creatinine [mg/dL]) was calculated using first available laboratory results. Children with scores >13 were designated as high-risk. We assessed score performance to predict severe adverse events (ie, dialysis, neurologic complication, respiratory failure, and death) using discrimination and net benefit (ie, threshold probability), with subgroup analyses by age and day-of-illness. Results A total of 167 children had HUS, of whom 92.8% (155/167) had relevant data to calculate the score; 60.6% (94/155) experienced a severe adverse event. Discrimination was acceptable overall (area under the curve 0.71, 95% CI 0.63-0.79) and better among children <5 years old (area under the curve 0.77, 95% CI 0.68-0.87). For children <5 years, greatest net benefit was achieved for a threshold probability >26%. Conclusions The HUS severity score was able to discriminate between high- and low-risk children <5 years old with STEC-associated HUS at a statistically acceptable level; however, it did not appear to provide clinical benefit at a meaningful risk threshold.
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