Berkley et al developed scores for identifying prognosis in sick children admitted to a district hospital in Kenya. These can help identify children who may benefit from more aggressive management. The authors are from the KEMRI Centre for Geographic Medicine Research in Kilifi, Kenya.
Parameters:
(1) anemia (hemoglobin < 5 g/dL)
(2) jaundice
(3) subcostal indrawing
(4) deep breathing (Kussmaul's respiration)
(5) prostration (unable to drink or breast feed if < 1 year; unable to sit unassisted if >= 1 year)
(6) impaired consciousness (non-directed eye movements if <= 8 months; unable to localize a painful stimulus if > 8 months)
(7) axillary temperature
(8) wasting (z score of weight for age < -3)
(9) kwashiorkor
(10) duration of illness
Point assignments was based on the natural logarithm of the adjusted likelihood ratio, rounded to an integer.
If a score had the potential for a negative score, a constant was added so that the minimum score was always 0.
NOTE: The point assignments for each parameter used in a score is given in Table 2. It is also stated that the maximum score for immediate death is 10, for early death is 7 and late death is 7. The tables below are arranged to give these values, but since the instructions are not explicit there is some guesswork involved.
|
Parameter |
Finding |
Points |
|---|---|---|
|
anemia |
>= 5 g/dL |
0 |
|
|
< 5 g/dL |
1 |
|
jaundice |
absent |
0 |
|
|
present |
1 |
|
subcostal indrawing |
absent |
-1 |
|
|
present |
1 |
|
deep breathing |
absent |
0 |
|
|
present |
1 |
|
neurologic status |
normal |
0 |
|
|
prostrated with seizures |
1 |
|
|
prostrated without seizures |
3 |
|
|
impaired consciousness with seizures |
2 |
|
|
impaired consciousness without seizures |
3 |
|
axillary temperature |
< 36°C |
1 |
|
|
36 – 39°C |
0 |
|
|
> 39°C |
-1 |
score for immediate death =
= SUM(points for the 6 parameters) + 2
|
Parameter |
Finding |
Points |
|---|---|---|
|
jaundice |
absent |
0 |
|
|
present |
1 |
|
subcostal indrawing |
absent |
0 |
|
|
present |
1 |
|
neurologic status |
normal |
0 |
|
|
prostrated with seizures |
2 |
|
|
prostrated without seizures |
2 |
|
|
impaired consciousness with seizures |
2 |
|
|
impaired consciousness without seizures |
3 |
|
wasting |
absent |
0 |
|
|
present |
1 |
|
kwashiorkor |
absent |
0 |
|
|
present |
1 |
score for early death =
= SUM(points for the 5 parameters)
|
Parameter |
Finding |
Points |
|---|---|---|
|
history of illness |
> 7 days |
1 |
|
|
<= 7 days |
0 |
|
neurologic status |
normal |
0 |
|
|
prostrated with seizures |
-1 |
|
|
prostrated without seizures |
0 |
|
|
impaired consciousness with seizures |
1 |
|
|
impaired consciousness without seizures |
1 |
|
axillary temperature |
< 36°C |
1 |
|
|
36 – 39°C |
0 |
|
|
> 39°C |
-1 |
|
wasting |
absent |
0 |
|
|
present |
1 |
|
kwashiorkor |
absent |
0 |
|
|
present |
1 |
score for late death =
= SUM(points for the 5 parameters) + 2
Interpretation:
• minimum scores: 0
• maximum score for immediate death: 10
• maximum score for early death: 7
• maximum score for late death: 7
ROC curves are given for each score, but the best decision point is not reported. Based on the curves shown, the best cut-off points (maximum Youden's indices) are:
(1) immediate score: >= 3
(2) early death: >= 1
(3) late death: >=2
Specialty: Pedatrics
ICD-10: ,
