ArticlePloS one2012
Development of the Respiratory Index of Severity in Children (RISC) score among young children with respiratory infections in South Africa.
Article in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03750747 (Assessing the Feasibility and Effectiveness of Introducing Pulse Oximetry in IMCI Services to Manage Acute Respiratory Infections at First Level Health Facilities of Bangladesh), which is not on this map. Cited by 86 papers, 9 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Assessing the Feasibility and Effectiveness of Introducing Pulse Oximetry in IMCI Services to Manage Acute Respiratory Infections at First Level Health Facilities of Bangladesh
Who cites it
86 citing papers in PubMed, 9 syntheses or guidelines pooled it.
- Hypoxaemia and mortality in children with lower respiratory infection in low-income and middle-income countries: systematic review and meta-analysis.The Lancet. Global health · 2026Pooled it
- What are the risk factors for death among children with pneumonia in low- and middle-income countries? A systematic review.Journal of global health · 2023Pooled it
- Which children with chest-indrawing pneumonia can be safely treated at home, and under what conditions is it safe to do so? A systematic review of evidence from low- and middle-income countries.Journal of global health · 2022Pooled it
- Prevalence of hypoxaemia in children with pneumonia in low-income and middle-income countries: a systematic review and meta-analysis.The Lancet. Global health · 2022Pooled it
- Prognostic models for predicting in-hospital paediatric mortality in resource-limited countries: a systematic review.BMJ open · 2020Pooled it
- Factors Associated With Pneumonia Severity in Children: A Systematic Review.Journal of the Pediatric Infectious Diseases Society · 2018Pooled it
- Pneumonia Risk Stratification Scores for Children in Low-Resource Settings: A Systematic Literature Review.The Pediatric infectious disease journal · 2018Pooled it
- Influenza and other respiratory viruses: standardizing disease severity in surveillance and clinical trials.Expert review of anti-infective therapy · 2017Pooled it
- Pooled it
- Factors associated with community acquired severe pneumonia among under five children in Dhaka, Bangladesh: A case control analysis.PloS one · 2022Trial
- Development of a scale for early prediction of refractory Mycoplasma pneumoniae pneumonia in hospitalized children.Scientific reports · 2021Trial
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- Trial
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- Oral amoxicillin versus benzyl penicillin for severe pneumonia among kenyan children: a pragmatic randomized controlled noninferiority trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2015Trial
- Pediatric community-acquired pneumonia: predictive value of heparin-binding protein for severity assessment.Pediatric research · 2026Observational
- Prediction of hospitalisation in young children with pneumonia in Malawi: A machine learning-based approach.PLoS medicine · 2026Article
- External Validation of Pediatric Pneumonia and Bronchiolitis Risk Scores to Predict Mortality in Children Hospitalized in Kenya: A Retrospective Cohort Study.The Journal of infectious diseases · 2026Article
- Development and validation of a machine learning model for critical progression risk in pediatric severe community-acquired pneumonia.Scientific reports · 2025Article
- Turning Data into Decisions: Clinically Driven Prognostic Tools for Pediatric Pneumonia.Indian journal of pediatrics · 2025Article
26 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivePneumonia is a leading cause of death in children worldwide. A simple clinical score predicting the probability of death in a young child with lower respiratory tract infection (LRTI) could aid clinicians in case management and provide a standardized severity measure during epidemiologic studies.
methodsWe analyzed 4,148 LRTI hospitalizations in children <24 months enrolled in a pneumococcal conjugate vaccine trial in South Africa from 1998-2001, to develop the Respiratory Index of Severity in Children (RISC). Using clinical data at admission, a multivariable logistic regression model for mortality was developed and statistically evaluated using bootstrap resampling techniques. Points were assigned to risk factors based on their coefficients in the multivariable model. A child's RISC score is the sum of points for each risk factor present. Separate models were developed for HIV-infected and non-infected children.
resultsSignificant risk factors for HIV-infected and non-infected children included low oxygen saturation, chest indrawing, wheezing, and refusal to feed. The models also included age and HIV clinical classification (for HIV-infected children) or weight-for-age (for non-infected children). RISC scores ranged up to 7 points for HIV-infected or 6 points for non-infected children and correlated with probability of death (0-47%, HIV-infected; 0-14%, non-infected). Final models showed good discrimination (area under the ROC curve) and calibration (goodness-of-fit).
conclusionThe RISC score incorporates a simple set of risk factors that accurately discriminate between young children based on their risk of death from LRTI, and may provide an objective means to quantify severity based on the risk of mortality.
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