Predicting Adverse Outcomes for Shiga Toxin-Producing E. coli Infections in Emergency Departments.

TitlePredicting Adverse Outcomes for Shiga Toxin-Producing E. coli Infections in Emergency Departments.
Publication TypeJournal Article
Year of Publication2021
AuthorsLin CYang, Xie J, Freedman SB, McKee R, 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 J, Hunley TE, Avva U, Porter R, Fein DM, Louie JP, Tarr GAM
Corporate AuthorsPediatric Emergency Research Canada(PERC) and Pediatric Emergency Medicine Collaborative Research Committee(PEMCRC) STEC Study Group
JournalJ Pediatr
Date Published2021 Jan 05

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 one of 38 participating EDs in North America between 2011 and 2015. The HUS severity score [hemoglobin (g/dL) plus two-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 (i.e. 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 (AUC 0.71, 95% CI 0.63, 0.79) and better among children <5 years old (AUC 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.

Alternate JournalJ Pediatr
PubMed ID33417918