Chu Yang Lin1, Jianling Xie2, Stephen B Freedman3, Ryan S McKee4, David Schnadower5, Phillip I Tarr6, Yaron Finkelstein7, Neil M Desai8, Roni D Lane9, Kelly R Bergmann10, Ron L Kaplan11, Selena Hariharan5, Andrea T Cruz12, Daniel M Cohen13, Andrew Dixon14, Sriram Ramgopal15, Elizabeth C Powell15, Jennifer Kilgar16, Kenneth A Michelson17, Martin Bitzan18, Kenneth Yen19, Garth D Meckler20, Amy C Plint21, Fran Balamuth22, Stuart Bradin23, Serge Gouin24, April J Kam25, James A Meltzer26, Tracy E Hunley27, Usha Avva28, Robert Porter29, Daniel M Fein30, Jeffrey P Louie31, Gillian A M Tarr32. 1. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. 2. Section of Pediatric Emergency Medicine, Department of Pediatric, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Section of Pediatric Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 4. Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK. 5. Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH. 6. Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University in St Louis, School of Medicine, St Louis, MO. 7. Divisions of Emergency Medicine and Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. 8. Division of Pediatric Emergency Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada. 9. Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT. 10. Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN. 11. Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA. 12. Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, TX. 13. Nationwide Children's Hospital & The Ohio State University, Columbus, OH. 14. University of Alberta, Stollery Children's Hospital, Women's and Children's Health Research Institute, Edmonton, Alberta, Canada. 15. Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL. 16. Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada. 17. Division of Emergency Medicine, Boston Children's Hospital, Boston, MA. 18. Division of Nephrology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada; Al Jalila Children's Hospital, Kidney Centre of Excellence, Dubai, United Arab Emirates. 19. Pediatric Emergency Medicine, Children's Medical Center, UT Southwestern, Dallas, TX. 20. Pediatrics and Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 21. Departments of Pediatrics and Emergency Medicine, University of Ottawa and the Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. 22. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 23. Children's Emergency Services, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI. 24. Departments of Pediatric Emergency Medicine & Pediatrics, CHU Sainte-Justine, Universite de Montreal, Quebec, Canada. 25. Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada. 26. Division of Emergency Medicine, Department of Pediatrics, Jacobi Medical Center, Bronx, NY. 27. Division of Pediatric Nephrology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN. 28. Department of Pediatrics, Joseph M. Sanzari Women and Children's Hospital, Hackensack University Medical Center, Hackensack, NJ. 29. Discipline of Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland, Canada. 30. Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY. 31. Division of Emergency Medicine, University of Minnesota, Masonic Children's Hospital, Minneapolis, MN. 32. Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN. Electronic address: gtarr@umn.edu.
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.
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.
Authors: Ryan S McKee; David Schnadower; Phillip I Tarr; Jianling Xie; Yaron Finkelstein; Neil Desai; Roni D Lane; Kelly R Bergmann; Ron L Kaplan; Selena Hariharan; Andrea T Cruz; Daniel M Cohen; Andrew Dixon; Sriram Ramgopal; Annie Rominger; Elizabeth C Powell; Jennifer Kilgar; Kenneth A Michelson; Darcy Beer; Martin Bitzan; Christopher M Pruitt; Kenneth Yen; Garth D Meckler; Amy C Plint; Stuart Bradin; Thomas J Abramo; Serge Gouin; April J Kam; Abigail Schuh; Fran Balamuth; Tracy E Hunley; John T Kanegaye; Nicholas E Jones; Usha Avva; Robert Porter; Daniel M Fein; Jeffrey P Louie; Stephen B Freedman Journal: Clin Infect Dis Date: 2020-04-10 Impact factor: 9.079
Authors: Julie A Ake; Srdjan Jelacic; Marcia A Ciol; Sandra L Watkins; Karen F Murray; Dennis L Christie; Eileen J Klein; Phillip I Tarr Journal: Pediatrics Date: 2005-06 Impact factor: 7.124
Authors: Christina A Hickey; T James Beattie; Jennifer Cowieson; Yosuke Miyashita; C Frederic Strife; Juliana C Frem; Johann M Peterson; Lavjay Butani; Deborah P Jones; Peter L Havens; Hiren P Patel; Craig S Wong; Sharon P Andreoli; Robert J Rothbaum; Anne M Beck; Phillip I Tarr Journal: Arch Pediatr Adolesc Med Date: 2011-07-22
Authors: Sebastian Loos; Jun Oh; Laura van de Loo; Markus J Kemper; Martin Blohm; Raphael Schild Journal: Pediatr Nephrol Date: 2021-05-27 Impact factor: 3.714