764 - Systematic Review of Risk Assessment Tools for Post-Discharge Mortality Among Children in sub-Saharan Africa

Publication Number: 764.6629

Ramya C. Ginjupalli, Emory University School of Medicine, Atlanta, GA, United States; Kaitlin Cole, Emory University School of Medicine, Decatur, GA, United States; Karim Manji, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Dar es Salaam, Tanzania; Rodrick R. Kisenge, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Dar es Salaam, Tanzania; Hannah K. Rogers, Emory University, Atlanta, GA, United States; Adrianna Westbrook, Emory University School of Medicine, Atlanta, GA, United States; Quique Bassat, ISGlobal, Barcelona, Catalonia, Spain; Inacio Mandomando, Centro de Investigação em Saúde de Manhiça, Maputo, Maputo, Mozambique; Claudia R.. Morris, Emory University School of Medicine, Atlanta, GA, United States; Nega Assefa, Haramaya University, Harar, Hareri Hizb, Ethiopia; Richard Omore, Kenya Medical Research Institute (KEMRI), Kisumu, Nyanza, Kenya; Kitiezo Aggrey. Igunza, Kenya Medical Research Institute, Kisumu, Nyanza, Kenya; Christopher Duggan, Boston Children's Hospital, Boston, MA, United States; Chris A. Rees, Emory University School of Medicine, Atlanta, GA, United States

Background: Rates of post-hospital discharge mortality (PDM) in sub-Saharan Africa are as high as 3-18%. Risk assessment tools have the potential to accurately identify children at risk for PDM. To be translated into clinical practice, risk assessment tools must be derived, validated, implemented, and their impact assessed. However, an understanding of the current state of tool development and implementation for PDM in sub-Saharan Africa is lacking.

Objective: To review the current state of risk assessment tools for PDM among children in sub-Saharan Africa

Design/Methods: We conducted a systematic review of publications reporting risk assessment tools for PDM among children in sub-Saharan Africa, the reporting of which was guided by the standards of the PRISMA statement. These were defined as tools using empiric clinical and laboratory data that assigned numeric scores to risk factors to predict PDM. We searched CABI Global Health, Cochrane Reviews, Cochrane Trials, ProQuest Dissertations and Theses, Embase, PubMed, Scopus, and Web of Science for publications with no date or language restriction. We used the Prediction Model Risk of Bias Assessment Tool (PROBAST) to assess the risk of bias in publications and determined level of evidence for each risk assessment tool using the Evidence-Based-Medicine Working Group hierarchy.

Results: Of 4,893 publications screened, 290 full texts were reviewed, and we identified eight publications that reported risk assessment tools for PDM among children in sub-Saharan Africa (Table). These studies were conducted in nine sub-Saharan African countries (two studies included sites in India, Bangladesh, and Pakistan) and half were conducted in single countries. These studies enrolled 48,529 total participants, of whom 4.0% (n=1,961) experienced PDM. There was substantial heterogeneity in included populations (e.g., age and diagnoses) and identified risk factors, although all identified malnutrition as a risk factor for PDM. All identified risk assessment tools had fair (i.e., area under the receiver operating characteristic curve [AUC] ≥0.70) or good (AUC ≥ 0.80) discriminatory value. Only one risk assessment tool had been externally validated, and none have been implemented. Four of the publications were low risk for bias per PROBAST.

Conclusion(s): Existing risk assessment tools to identify children at risk for PDM in sub-Saharan Africa lack broad validation and implementation. Malnutrition is a common risk factor for PDM. Further studies are urgently needed to validate and implement such tools to aid in the reduction of PDM among children in sub-Saharan Africa.

Table. Characteristics of included publications on the derivation, validation, and implementation of risk assessment tools for post-discharge mortality among children in sub-Saharan Africa


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