Predicting Adverse Outcomes for Shiga Toxin–Producing Escherichia coli Infections in Emergency Departments

• Published in: The Journal of pediatrics 2021-05, Vol.232, p.200-206.e4
• Main Authors: Lin, Chu Yang, Xie, Jianling, Freedman, Stephen B., McKee, Ryan S., Schnadower, David, Tarr, Phillip I., Finkelstein, Yaron, Desai, Neil M., Lane, Roni D., Bergmann, Kelly R., Kaplan, Ron L., Hariharan, Selena, Cruz, Andrea T., Cohen, Daniel M., Dixon, Andrew, Ramgopal, Sriram, Powell, Elizabeth C., Kilgar, Jennifer, Michelson, Kenneth A., Bitzan, Martin, Yen, Kenneth, Meckler, Garth D., Plint, Amy C., Balamuth, Fran, Bradin, Stuart, Gouin, Serge, Kam, April J., Meltzer, James A., Hunley, Tracy E., Avva, Usha, Porter, Robert, Fein, Daniel M., Louie, Jeffrey P., Tarr, Gillian A.M., Rominger, Annie, Beer, Darcy, Pruitt, Christopher M., Abramo, Thomas J., Schuh, Abigail, Kanegaye, John T., Jones, Nicholas E.
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Clinical Decision Rules; Emergency Service, Hospital; Escherichia coli Infections - complications; Escherichia coli Infections - diagnosis; Escherichia coli Infections - mortality; Female; hemolytic uremic syndrome; Hemolytic-Uremic Syndrome - complications; Hemolytic-Uremic Syndrome - diagnosis; Hemolytic-Uremic Syndrome - mortality; Humans; Infant; Infant, Newborn; Male; North America; Prognosis; prognostic index; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Shiga-Toxigenic Escherichia coli; stx1; stx2
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2020.12.077

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. We reviewed medical records of children 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. 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