scholarly journals Risk-stratification of febrile African children at risk of sepsis using sTREM-1 as basis for a rapid triage test

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Aleksandra Leligdowicz ◽  
Andrea L. Conroy ◽  
Michael Hawkes ◽  
Melissa Richard-Greenblatt ◽  
Kathleen Zhong ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Accuracy ◽  
Negative Likelihood Ratio ◽  
Endothelial Activation ◽  
Children At Risk ◽  
Low Resource Settings ◽  
Low Resource ◽  
Risk Of Death ◽  
Fever Syndromes ◽  
Triage Test

AbstractIdentifying febrile children at risk of sepsis in low-resource settings can improve survival, but recognition triage tools are lacking. Here we test the hypothesis that measuring circulating markers of immune and endothelial activation may identify children with sepsis at risk of all-cause mortality. In a prospective cohort study of 2,502 children in Uganda, we show that Soluble Triggering Receptor Expressed on Myeloid cells-1 (sTREM-1) measured at first clinical presentation, had high predictive accuracy for subsequent in-hospital mortality. sTREM-1 had the best performance, versus 10 other markers, with an AUROC for discriminating children at risk of death of 0.893 in derivation (95% CI 0.843–0.944) and 0.901 in validation (95% CI 0.856–0.947) cohort. sTREM-1 cutoffs corresponding to a negative likelihood ratio (LR) of 0.10 and a positive LR of 10 classified children into low (1,306 children, 53.1%), intermediate (942, 38.3%) and high (212, 8.6%) risk zones. The estimated incidence of death was 0.5%, 3.9%, and 31.8%, respectively, suggesting sTREM-1 could be used to risk-stratify febrile children. These findings do not attempt to derive a risk prediction model, but rather define sTREM-1 cutoffs as the basis for rapid triage test for all cause fever syndromes in children in low-resource settings.

scholarly journals Risk-stratification of febrile African children at risk of sepsis using sTREM-1 as basis for a rapid triage test

2020 ◽  
Author(s):  
Aleksandra Leligdowicz ◽  
Andrea Conroy ◽  
Michael Hawkes ◽  
Melissa Richard-Grennblatt ◽  
Kathleen Zhong ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Accuracy ◽  
External Validation ◽  
Negative Likelihood Ratio ◽  
Endothelial Activation ◽  
Children At Risk ◽  
Low Resource Settings ◽  
Low Resource ◽  
Risk Of Death ◽  
Triage Test

Abstract Identifying febrile children at risk of sepsis in low-resource settings can improve survival, but recognition triage tools are lacking. Here we test the hypothesis that measuring circulating markers of immune and endothelial activation may identify children at risk of sepsis due to all causes. In a prospective cohort study of 2,502 children in Uganda, we show that Soluble Triggering Receptor Expressed on Myeloid cells-1 (sTREM-1) measured at first clinical presentation, had high predictive accuracy for subsequent in-hospital mortality. sTREM-1 had the best performance, versus 10 other markers, with an AUROC for discriminating children at risk of death of 0.893 in derivation (95% CI 0.843-0.944) and 0.901 in external validation (95% CI 0.856-0.947). sTREM-1 cutoffs corresponding to a negative likelihood ratio (LR) of 0.10 and a positive LR of 10 classified children into low (1306 children, 53.1%), intermediate (942, 38.3%) and high (212, 8.6%) risk zones. The estimated incidence of death was 0.3%, 3.6%, and 31.0%, respectively, suggesting sTREM-1 could be used to risk-stratify febrile children. These findings support sTREM-1 as the basis for rapid triage test for all cause fever syndromes in children in low-resource settings.

Identifying children at risk of death within 30 days of surgery at an NSQIP pediatric hospital

Surgery ◽  
2015 ◽  
Vol 158 (6) ◽  
pp. 1481-1491 ◽  
Author(s):  
Max R. Langham ◽  
Arianne Walter ◽  
Timothy C. Boswell ◽  
Robert Beck ◽  
Tamekia L. Jones
Keyword(s):  
At Risk ◽  
Pediatric Hospital ◽  
Children At Risk ◽  
Risk Of Death

scholarly journals Causes and consequences of child growth failure in low- and middle-income countries

2020 ◽  
Author(s):  
Andrew Mertens ◽  
Jade Benjamin-Chung ◽  
John M Colford ◽  
Jeremy Coyle ◽  
Mark J van der Laan ◽  
...  
Keyword(s):  
Growth Failure ◽  
Postnatal Growth ◽  
Early Growth ◽  
Child Growth ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
Risk Of Death ◽  
Household Environment ◽  
Postnatal Growth Failure

AbstractChild growth failure is associated with a higher risk of illness and mortality,1 which contributed to the United Nations Sustainable Development Goal 2.2 to end malnutrition by 2030. Current prenatal and postnatal interventions, such as nutritional supplementation, have been insufficient to eliminate growth failure in low resource settings —motivating a search for key age windows and population subgroups in which to focus future preventive efforts. Quantifying the effect of early growth failure on severe outcomes is important to assess burden and longer-term impacts on the child. Here we show through an analysis of 35 longitudinal cohorts (108,336 children) that maternal and child characteristics at birth accounted for the largest attributable differences in growth. Yet, postnatal growth failure was larger than differences at birth, and characteristics of the child’s household environment were additional determinants of growth failure after age 6 months. Children who experienced early ponderal or linear growth failure were at much higher risk of persistent growth failure and were 2.0 to 4.8 times more likely to die by age 24 months. High attributable risk from prenatal causes, and severe consequences for children who experienced early growth failure, support a focus on pre-conception and pregnancy as key opportunities for new preventive interventions. Our results suggest that broad improvements in wellbeing will be necessary to eliminate growth failure in low resource settings, but that screening based on weight could help identify children at highest risk of death before age 24 months.

scholarly journals Evaluation of cytology as secondary triage in visual inspection after application of 4% acetic acid-based cervical cancer screening program

2019 ◽  
Vol 08 (02) ◽  
pp. 102-107
Author(s):  
Gauravi A. Mishra ◽  
Sharmila A. Pimple ◽  
Subhadra D. Gupta
Keyword(s):  
Cervical Cancer ◽  
Acetic Acid ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Visual Inspection ◽  
Substantial Reduction ◽  
Predictive Values ◽  
Low Resource Settings ◽  
Low Resource ◽  
Triage Test

Abstract Context (Background): Visual-based screening techniques are low cost and have good sensitivity. Hence, they appear promising for primary screening in low-resource settings. However, to reduce referrals for diagnostic colposcopy, there is need to triage these screen-positive women with test with good specificity. Aims: The study aims to evaluate the performance of cytology as triage for visual inspection after application of 4% acetic acid (VIA) screen-positive women. Settings and Design: Community-based cervical cancer screening using VIA was implemented among socioeconomically disadvantaged women in Mumbai, India. Methods: Cytology was performed on screen-positive women. All primarily screen-positive women underwent colposcopy. Directed biopsies were obtained among women with positive findings on colposcopy. The gold standard used for final disease status was histopathology or negative colposcopy. Statistical Analysis Used: Test characteristics of cytology as triage test. Results: Among the 138,383 population, 16,424 eligible women were screened with VIA. 785 (4.78%) women were VIA positive and 580 women participated in triage with cytology. The sensitivity and specificity of cytology at threshold of atypical squamous cells of undetermined significance in detecting ≥cervical intraepithelial neoplasia (CIN) 2 were 75.0 and 94.7, respectively. The positive and negative predictive values of cytology as triage test were 23.1 and 99.4, respectively, and the false positivity and false negativity rates were 5.34 and 25.0, respectively. Conclusion: Cytology triage with VIA can reduce referrals for colposcopy to 4.97% of original referrals but may miss around 25%, of high-grade CIN. The substantial reduction in referrals has special implication for low-resource settings, wherein compliance to referral and availability of diagnostic facilities are poor.

scholarly journals Rapid Diagnostic Tests for a Coordinated Approach to Fever Syndromes in Low-Resource Settings

2012 ◽  
Vol 55 (4) ◽  
pp. 610-611 ◽  
Author(s):  
C. P. Yansouni ◽  
E. Bottieau ◽  
F. Chappuis ◽  
M.-F. Phoba ◽  
O. Lunguya ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Rapid Diagnostic Tests ◽  
Low Resource Settings ◽  
Low Resource ◽  
Fever Syndromes

Identification of At-risk Pregnant Population for Over-the-Counter Drug Usage in Low-Resource Settings

2021 ◽  
Author(s):  
Aashima Arora ◽  
M. Praveen Kumar ◽  
Aishwarya Anand ◽  
Lekha Saha ◽  
Pradip Kumar Saha ◽  
...  
Keyword(s):  
At Risk ◽  
Drug Usage ◽  
Over The Counter ◽  
Low Resource Settings ◽  
Low Resource

Discriminant Validation of the Test of Reading Performance (TORP) for Identifying Children at Risk of Reading Difficulties

2000 ◽  
Vol 16 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Padeliadu Susana ◽  
Georgios D. Sideridis
Keyword(s):  
At Risk ◽  
Elementary School Students ◽  
Reading Difficulties ◽  
Reading Performance ◽  
Low Achievers ◽  
Children At Risk ◽  
School Students ◽  
Students At Risk ◽  
Group A ◽  
The Mean

Abstract This study investigated the discriminant validation of the Test of Reading Performance (TORP), a new scale designed to evaluate the reading performance of elementary-school students. The sample consisted of 181 elementary-school students drawn from public elementary schools in northern Greece using stratified random procedures. The TORP was hypothesized to measure six constructs, namely: “letter knowledge,” “phoneme blending,” “word identification,” “syntax,” “morphology,” and “passage comprehension.” Using standard deviations (SD) from the mean, three groups of students were formed as follows: A group of low achievers in reading (N = 9) including students who scored between -1 and -1.5 SD from the mean of the group. A group of students at risk of reading difficulties (N = 6) including students who scored between -1.5 and -2 SDs below the mean of the group. A group of students at risk of serious reading difficulties (N = 6) including students who scored -2 or more SDs below the mean of the group. The rest of the students (no risk, N = 122) comprised the fourth group. Using discriminant analyses it was evaluated how well the linear combination of the 15 variables that comprised the TORP could discriminate students of different reading ability. Results indicated that correct classification rates for low achievers, those at risk for reading problems, those at risk of serious reading problems, and the no-risk group were 89%, 100%, 83%, and 97%, respectively. Evidence for partial validation of the TORP was provided through the use of confirmatory factor analysis and indices of sensitivity and specificity. It is concluded that the TORP can be ut ilized for the identification of children at risk for low achievement in reading. Analysis of the misclassified cases indicated that increased variability might have been responsible for the existing misclassification. More research is needed to determine the discriminant validation of TORP with samples of children with specific reading disabilities.

Selected Conflicts in Children at Risk: A Whirlwind Tour

PsycCRITIQUES ◽  
2014 ◽  
Vol 59 (8) ◽  
Author(s):  
Richard Thompson ◽  
Elizabeth C. Neilson
Keyword(s):  
At Risk ◽  
Children At Risk
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