Identifying risk of death in children hospitalized with community-acquired pneumonia

OBJECTIVE: To externally validate a tool developed by the Pneumonia Research Partnership to Assess WHO Recommendations study group for identification of the risk of death in children hospitalized with community-acquired pneumonia, the PREPARE tool. METHODS: We did a secondary analysis of data collected during hospital-based surveillance of children with community-acquired pneumonia in northern India from January 2015 to February 2022. We included children aged 2–59 months with pulse oximetry assessment. We used multivariable backward stepwise logistic regression analysis to assess the strength of association of the PREPARE variables (except hypothermia) with pneumonia-related death. We estimated sensitivity, specificity, and positive and negative likelihood ratios of the PREPARE score at cut-off scores ≥ 3, ≥ 4 and ≥ 5. FINDINGS: Of 10 943 children screened, 6745 (61.6%) were included in our analysis, of whom 93 (1.4%) died. Age of < 1 year, female sex, weight-for-age < −3 standard deviations, respiratory rate of ≥ 20 breaths/min higher than the age-specific cut-off, and lethargy, convulsions, cyanosis and blood oxygen saturation < 90% were associated with death. In the validation, the PREPARE score had the highest sensitivity (79.6%) with concurrent highest specificity (72.5%) to identify hospitalized children at risk of death from community-acquired pneumonia at a cut-off score of ≥ 5. Area under curve was 0.82 (95% confidence interval: 0.77–0.86). CONCLUSION: The PREPARE tool with pulse oximetry showed good discriminatory ability on external validation in northern India. The tool can be used to assess risk of death of hospitalized children aged 2–59 months with community-acquired pneumonia for early referral to higher-level facilities.