Validity of Pneumonia Severity Assessment Scores in Africa and South Asia: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy and Data Sources
2.2. Study Selection
2.2.1. Eligibility Criteria
2.2.2. Screening
2.3. Data Extraction and Quality Assessment
2.4. Data Analysis
3. Results
3.1. Search Results
3.2. Study Characteristics
3.3. Methodological Quality
3.4. Study Outcome
3.5. Analysis of the Outcome
3.5.1. Association between CURB-65/CRB-65 and Mortality
3.5.2. CURB-65 Predictive Performance for Mortality
3.5.3. CRB-65 Predictive Performance for Mortality
3.6. Publication Bias
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author. (Year) | Country | Study Settings | Study Design | Age in Years | Male n (%) | Sample Size | Assessed Score(s) | Outcome(s) | Mortality Definition | Mortality Rate (%) |
---|---|---|---|---|---|---|---|---|---|---|
Abd-El-Gawad (2013) [35] | Egypt | Ain Shams University Hospitals | Prospective cohort | 69.9 (±11.4) | 42 (60) | 65 | CURB-65, SCAP and ADL | Mortality and MV | 30-day mortality | 40 |
Aston (2019) [34] | Malawi | Queen Elizabeth Central Hospital | Prospective observational | 34.7 (29.4–41.9) a | 285 (62.1) | 459 | CURB-65, CRB-65, SMRT-CO, SWAT-Bp and Modified IDSA/ATS | Mortality | 30-day mortality | 14.6 b |
Birkhamshaw (2013) [19] | Malawi | Medical admission ward of Queen Elizabeth Central Hospital | Retrospective | 37 (29–48) a | 116 (48.3) | 240 | SWAT-Bp and CRB-65 | Mortality | In-hospital mortality | 18.3 |
Buss (2018) [18] | Malawi | Medical admission ward of Queen Elizabeth Central Hospital | Prospective cohort | 35 (16–79) | 90 (41.7) | 216 | SWAT-Bp | Mortality | In-hospital mortality | 12.5 |
Kabundji (2014) [29] | South Africa | ED at Helen Joseph Hospital | Prospective observational | 36.5 (20–87) | 73 (48.0) | 152 | CRB-65 | Mortality, hospital admission and time to clinical stability | During hospitalisation or 2 weeks after ED visit | 3.3 |
Koss (2015) [17] | Uganda | Mulago Hospital | Prospective cohort | Mean: 34 | 389 (46.6) | 835 | Koss et al. new score | Mortality | 30-day mortality | 18.2 |
Mbata (2014) [30] | Nigeria | The Accident and Emergency, medical outpatients and medical wards of the University of Nigeria Teaching Hospital | Prospective observational | 56 (±18) | 39 (48.8) | 80 | CURB-65 and CRB-65 | Mortality and ICU admission | 30-day mortality | 15 |
Millman (2017) [33] | South Africa | Tshepong Hospital, Chris Hani Baragwanath Academic Hospital, and Selby Hospital | Retrospective chart review | NR | 2780 (38.6) | 1356 | CURB-65, CRB-65, CTA, CURB-45 and ACHU | Mortality | In-hospital mortality | 7.4 |
Rajarajan (2017) [36] | India | A tertiary care hospital | Prospective observational | 43.38 ± 16.43 | 29 (58) | 50 | PSI | Mortality | In-hospital or within 30 days of discharge | 2 |
Shah (2010) [31] | India | Out- and in-patient departments of Sher-i-Kashmir Institute of Medical Sciences | Prospective study | 60.8 (±13.6) | 89 (59.3) | 150 | CURB-65 and PSI | Mortality and ICU admission | In-hospital or within 30 days of discharge | 10.7 |
Zuberi (2008) [32] | Pakistan | Aga Khan University Hospital, | Longitudinal observational cohort | 60.4 (±18.5) | 65 (47.7) | 137 | CURB-65 and CRB-65 | Mortality | 30-day mortality | 13.1 |
High-Risk Cut-Offs | Intermediate-Risk Cut-Offs | |||
---|---|---|---|---|
CURB-65 ≥ 3 | CRB-65 ≥ 3 | CURB-65 ≥ 2 | CRB-65 ≥ 1 | |
Pooled Estimate | Summary Statistic | Summary Statistic | Summary Statistic | Summary Statistic |
Sensitivity (95% CI) | 0.70 (0.25–0.94) | 0.09 (0.01–0.48) | 0.96 (0.49–1.00) | 0.93 (0.50–0.99) |
Specificity (95% CI) | 0.90 (0.73–0.96) | 0.99 (0.95–1.00) | 0.64 (0.45–0.79) | 0.43 (0.24–0.64) |
PLR (95% CI) | 6.72 (3.84–11.76) | 8.65 (2.70–27.66) | 2.65 (1.77–3.98) | 1.64 (1.19–2.26) |
NLR (95% CI) | 0.33 (0.09–1.17) | 0.92 (0.77–1.11) | 0.06 (0.00–1.12) | 0.15 (0.02–1.47) |
DOR (95% CI) | 20.19 (7.32–55.63) | 9.36 (2.57–34.03) | 41.02 (2.87–586.97) | 10.70 (1.04–109.87) |
AUROC (95% CI) | 0.90 (0.87–0.93) | 0.91 (0.88–0.93) | 0.81 (0.77–0.84) | 0.70 (0.66–0.74) |
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Al Hussain, S.K.; Kurdi, A.; Abutheraa, N.; AlDawsari, A.; Sneddon, J.; Godman, B.; Seaton, R.A. Validity of Pneumonia Severity Assessment Scores in Africa and South Asia: A Systematic Review and Meta-Analysis. Healthcare 2021, 9, 1202. https://doi.org/10.3390/healthcare9091202
Al Hussain SK, Kurdi A, Abutheraa N, AlDawsari A, Sneddon J, Godman B, Seaton RA. Validity of Pneumonia Severity Assessment Scores in Africa and South Asia: A Systematic Review and Meta-Analysis. Healthcare. 2021; 9(9):1202. https://doi.org/10.3390/healthcare9091202
Chicago/Turabian StyleAl Hussain, Sarah Khalid, Amanj Kurdi, Nouf Abutheraa, Asma AlDawsari, Jacqueline Sneddon, Brian Godman, and Ronald Andrew Seaton. 2021. "Validity of Pneumonia Severity Assessment Scores in Africa and South Asia: A Systematic Review and Meta-Analysis" Healthcare 9, no. 9: 1202. https://doi.org/10.3390/healthcare9091202