Patient population: pediatric
Parameters:
(1) clinical severity (using the clinical severity score, above)
(2) membrane score (using the membrane score, above)
(3) neck appearance
(4) coagulation status
(5) breathing
(6) throat culture result for Corynebacterium diphtheriae (NOTE: The authors use the genus Clostridium.)
The odds ratios for cardiomyopathy ranged from:
(1) 5.5 (for stridor requiring tracheostomy)
(2) 14 (for coagulopathy and culture isolate)
(3) 22 (for clinically severe and bull neck)
(4) 31 (for membrane score)
I tried to use this data to develop a risk score. The point assignment is based on rounding stridor to 6 and then dividing this into the other odds ratios and rounding down.
|
Parameter
|
Finding
|
Relative Points (Proposed)
|
|
clinical severity
|
asymptomatic to moderate
|
0
|
|
|
severe
|
3
|
|
membrane score
|
0 to 2
|
0
|
|
|
3 or 4
|
5
|
|
neck appearance
|
normal to mild swelling
|
0
|
|
|
bull neck
|
3
|
|
coagulation status
|
normal
|
0
|
|
|
coagulopathy
|
2
|
|
breathing
|
normal to stridor not requiring tracheostomy
|
0
|
|
|
stridor requiring tracheostomy
|
1
|
|
throat culture
|
negative for C. diphtheriae
|
0
|
|
|
positive for C. diphtheriae
|
2
|
proposed total relative score =
= SUM(points for the 6 parameters)
Interpretation:
• minimum total relative score: 0
• maximum total relative score: 16
• An odds ratio of 5.5 suggests a moderate risk to me. Using this as the baseline, I have assigned 2 or 3 as moderate to high, 4 or 5 as high, and 6 or more as very high.
Limitation:
• The total relative score and its interpretation are totally untested.
