Faculty Collaboration Database

Predicting Adverse Outcomes for Shiga Toxin-Producing Escherichia coli Infections in Emergency Departments. J Pediatr 2021 May;232:200-206.e4

Date

01/09/2021

Pubmed ID

33417918

Pubmed Central ID

PMC8084908

DOI

10.1016/j.jpeds.2020.12.077

Scopus ID

2-s2.0-85101350537 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

OBJECTIVE: To assess the performance of a hemolytic uremic syndrome (HUS) severity score among children with Shiga toxin-producing Escherichia coli (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.

Author List

Lin CY, Xie J, Freedman SB, McKee RS, Schnadower D, Tarr PI, Finkelstein Y, Desai NM, Lane RD, Bergmann KR, Kaplan RL, Hariharan S, Cruz AT, Cohen DM, Dixon A, Ramgopal S, Powell EC, Kilgar J, Michelson KA, Bitzan M, Yen K, Meckler GD, Plint AC, Balamuth F, Bradin S, Gouin S, Kam AJ, Meltzer JA, Hunley TE, Avva U, Porter R, Fein DM, Louie JP, Tarr GAM, Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Medicine Collaborative Research Committee (PEMCRC) STEC Study Group

Author

Abigail M. Schuh MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Emergency Service, Hospital
Escherichia coli Infections
Female
Hemolytic-Uremic Syndrome
Humans
Infant
Infant, Newborn
Male
North America
Prognosis
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Shiga-Toxigenic Escherichia coli