{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T04:37:19Z","timestamp":1775277439996,"version":"3.50.1"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T00:00:00Z","timestamp":1714348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004828","name":"Grand Challenges Canada","doi-asserted-by":"publisher","award":["TTS-1809-1939"],"award-info":[{"award-number":["TTS-1809-1939"]}],"id":[{"id":"10.13039\/501100004828","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005627","name":"Thrasher Research Fund","doi-asserted-by":"publisher","award":["13878"],"award-info":[{"award-number":["13878"]}],"id":[{"id":"10.13039\/100005627","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011775","name":"BC Children\u2019s Hospital Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011775","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Mining4Life"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>In many low-income countries, over five percent of hospitalized children die following hospital discharge. The lack of available tools to identify those at risk of post-discharge mortality has limited the ability to make progress towards improving outcomes. We aimed to develop algorithms designed to predict post-discharge mortality among children admitted with suspected sepsis. Four prospective cohort studies of children in two age groups (0\u20136 and 6\u201360 months) were conducted between 2012\u20132021 in six Ugandan hospitals. Prediction models were derived for six-months post-discharge mortality, based on candidate predictors collected at admission, each with a maximum of eight variables, and internally validated using 10-fold cross-validation. 8,810 children were enrolled: 470 (5.3%) died in hospital; 257 (7.7%) and 233 (4.8%) post-discharge deaths occurred in the 0-6-month and 6-60-month age groups, respectively. The primary models had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95%CI 0.74\u20130.80) for 0-6-month-olds and 0.75 (95%CI 0.72\u20130.79) for 6-60-month-olds; mean AUROCs among the 10 cross-validation folds were 0.75 and 0.73, respectively. Calibration across risk strata was good: Brier scores were 0.07 and 0.04, respectively. The most important variables included anthropometry and oxygen saturation. Additional variables included: illness duration, jaundice-age interaction, and a bulging fontanelle among 0-6-month-olds; and prior admissions, coma score, temperature, age-respiratory rate interaction, and HIV status among 6-60-month-olds. Simple prediction models at admission with suspected sepsis can identify children at risk of post-discharge mortality. Further external validation is recommended for different contexts. Models can be digitally integrated into existing processes to improve peri-discharge care as children transition from the hospital to the community.<\/jats:p>","DOI":"10.1371\/journal.pgph.0003050","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T13:24:42Z","timestamp":1714397082000},"page":"e0003050","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Prediction models for post-discharge mortality among under-five children with suspected sepsis in Uganda: A multicohort analysis"],"prefix":"10.1371","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3287-5181","authenticated-orcid":true,"given":"Matthew O.","family":"Wiens","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vuong","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey N.","family":"Bone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elias","family":"Kumbakumba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Businge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abner","family":"Tagoola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheila Oyella","family":"Sherine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Byaruhanga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Ssemwanga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celestine","family":"Barigye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesca","family":"Nsungwa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Olaro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8427-2035","authenticated-orcid":true,"given":"J. Mark","family":"Ansermino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7853-4075","authenticated-orcid":true,"given":"Niranjan","family":"Kissoon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Singer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4253-5594","authenticated-orcid":true,"given":"Charles P.","family":"Larson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascal M.","family":"Lavoie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dustin","family":"Dunsmuir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter P.","family":"Moschovis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2715-091X","authenticated-orcid":true,"given":"Stefanie","family":"Novakowski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare","family":"Komugisha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mellon","family":"Tayebwa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas","family":"Mwesigwa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Knappett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8382-5136","authenticated-orcid":true,"given":"Nicholas","family":"West","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan Kenya","family":"Mugisha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1912-1032","authenticated-orcid":true,"given":"Jerome","family":"Kabakyenga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,4,29]]},"reference":[{"key":"pgph.0003050.ref001","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: analysis for the Global Burden of Disease Study","volume":"395","author":"KE Rudd","year":"2020","journal-title":"Lancet"},{"key":"pgph.0003050.ref002","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1186\/s13054-018-2157-z","article-title":"The global burden of sepsis: barriers and potential solutions.","volume":"22","author":"KE Rudd","year":"2018","journal-title":"Crit Care"},{"key":"pgph.0003050.ref003","doi-asserted-by":"crossref","first-page":"2666","DOI":"10.21037\/tp-20-390","article-title":"Challenges in pediatric post-sepsis care in resource limited settings: a narrative review.","volume":"10","author":"MO Wiens","year":"2021","journal-title":"Transl Pediatr"},{"key":"pgph.0003050.ref004","doi-asserted-by":"crossref","first-page":"102380","DOI":"10.1016\/j.eclinm.2023.102380","article-title":"Pediatric post-discharge mortality in resource-poor countries: a systematic review and meta-analysis.","volume":"67","author":"M Knappett","year":"2024","journal-title":"EClinicalMedicine."},{"key":"pgph.0003050.ref005","doi-asserted-by":"crossref","first-page":"e673","DOI":"10.1016\/S2214-109X(22)00118-8","article-title":"Network. Childhood mortality during and after acute illness in Africa and south Asia: a prospective cohort study","volume":"10","year":"2022","journal-title":"Lancet Glob Heal"},{"key":"pgph.0003050.ref006","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S2352-4642(23)00052-4","article-title":"Mortality after hospital discharge among children younger than 5 years admitted with suspected sepsis in Uganda: a prospective, multisite, observational cohort study","volume":"7","author":"MO Wiens","year":"2023","journal-title":"Lancet Child Adolesc Heal"},{"key":"pgph.0003050.ref007","doi-asserted-by":"crossref","first-page":"e023445","DOI":"10.1136\/bmjopen-2018-023445","article-title":"Paediatric postdischarge mortality in developing countries: a systematic review","volume":"8","author":"B Nemetchek","year":"2018","journal-title":"BMJ Open"},{"key":"pgph.0003050.ref008","doi-asserted-by":"crossref","first-page":"e0249569","DOI":"10.1371\/journal.pone.0249569","article-title":"Knowledge, attitudes, and perceptions of Kenyan healthcare workers regarding pediatric discharge from hospital.","volume":"16","author":"S Paul","year":"2021","journal-title":"PLoS One"},{"key":"pgph.0003050.ref009","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1186\/s12913-021-07272-9","article-title":"Out of pocket costs and time\/productivity losses for pediatric sepsis in Uganda: a mixed-methods study.","volume":"21","author":"A Krepiakevich","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"pgph.0003050.ref010","doi-asserted-by":"crossref","first-page":"e029526","DOI":"10.1136\/bmjopen-2019-029526","article-title":"Exploring healthcare providers\u2019 perspectives of the paediatric discharge process in Uganda: a qualitative exploratory study","volume":"9","author":"B Nemetchek","year":"2019","journal-title":"BMJ Open"},{"key":"pgph.0003050.ref011","doi-asserted-by":"crossref","first-page":"883","DOI":"10.4314\/ahs.v16i4.2","article-title":"Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study.","volume":"16","author":"L English","year":"2016","journal-title":"Afr Health Sci"},{"key":"pgph.0003050.ref012","doi-asserted-by":"crossref","first-page":"e0001937","DOI":"10.1371\/journal.pgph.0001937","article-title":"Derivation and external validation of a clinical prognostic model identifying children at risk of death following presentation for diarrheal care.","volume":"3","author":"SM Ahmed","year":"2023","journal-title":"PLOS Glob public Heal."},{"key":"pgph.0003050.ref013","doi-asserted-by":"crossref","first-page":"e009449","DOI":"10.1136\/bmjopen-2015-009449","article-title":"Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models","volume":"5","author":"MO Wiens","year":"2015","journal-title":"BMJ Open"},{"key":"pgph.0003050.ref014","doi-asserted-by":"crossref","first-page":"55","DOI":"10.7326\/M14-0697","article-title":"Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): The TRIPOD Statement.","volume":"162","author":"GS Collins","year":"2015","journal-title":"Ann Intern Med"},{"key":"pgph.0003050.ref015","year":"2022","journal-title":"Uganda Bureau of StatisticsPopulation & Censuses."},{"key":"pgph.0003050.ref016","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/01.PCC.0000149131.72248.E6","article-title":"International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics","volume":"6","author":"B Goldstein","year":"2005","journal-title":"Pediatr Crit Care Med"},{"key":"pgph.0003050.ref017","article-title":"Smart Discharges to improve post-discharge health outcomes in children: A prospective before-after study with staggered implementation.","author":"M Wiens","year":"2023","journal-title":"Borealis, V1"},{"key":"pgph.0003050.ref018","doi-asserted-by":"crossref","first-page":"162","DOI":"10.4314\/ahs.v16i1.22","article-title":"Selecting candidate predictor variables for the modelling of post-discharge mortality from sepsis: a protocol development project","volume":"16","author":"MO Wiens","year":"2016","journal-title":"Afr Health Sci"},{"key":"pgph.0003050.ref019","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.4314\/ahs.v18i4.43","article-title":"Predictor variables for post-discharge mortality modelling in infants: a protocol development project","volume":"18","author":"BR Nemetchek","year":"2018","journal-title":"Afr Health Sci"},{"key":"pgph.0003050.ref020","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support.","volume":"42","author":"PA Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"pgph.0003050.ref021","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners.","volume":"95","author":"PA Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"pgph.0003050.ref022","first-page":"245","article-title":"Facing Imbalanced Data Recommendations for the Use of Performance Metrics.","volume":"2013","author":"LA Jeni","year":"2013","journal-title":"Int Conf Affect Comput Intell Interact Work [proceedings] ACII"},{"key":"pgph.0003050.ref023","doi-asserted-by":"crossref","DOI":"10.18637\/jss.v028.i05","article-title":"Building Predictive Models in R Using the caret Package.","volume":"28","author":"M. Kuhn","year":"2008","journal-title":"J Stat Softw."},{"key":"pgph.0003050.ref024","volume-title":"R: A language and environment for statistical computing.","author":"R Core Team","year":"2021"},{"key":"pgph.0003050.ref025","doi-asserted-by":"crossref","first-page":"422","DOI":"10.9745\/GHSP-D-16-00069","article-title":"Scheduled Follow-Up Referrals and Simple Prevention Kits Including Counseling to Improve Post-Discharge Outcomes Among Children in Uganda: A Proof-of-Concept Study.","volume":"4","author":"MO Wiens","year":"2016","journal-title":"Glob Heal Sci Pract"},{"key":"pgph.0003050.ref026","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S2352-4642(22)00375-3","article-title":"Tackling post-discharge mortality in children living in LMICs to reduce child deaths","volume":"7","author":"S Akech","year":"2023","journal-title":"Lancet Child Adolesc Heal"},{"key":"pgph.0003050.ref027","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1001\/jamapediatrics.2017.4519","article-title":"Smart Hospital Discharges to Address a Neglected Epidemic in Sepsis in Low- and Middle-Income Countries","volume":"172","author":"MO Wiens","year":"2018","journal-title":"JAMA Pediatr"},{"key":"pgph.0003050.ref028","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1373\/clinchem.2008.115345","article-title":"Dealing with missing predictor values when applying clinical prediction models","volume":"55","author":"KJM Janssen","year":"2009","journal-title":"Clin Chem"},{"key":"pgph.0003050.ref029","doi-asserted-by":"crossref","first-page":"3591","DOI":"10.1002\/sim.8682","article-title":"Handling missing predictor values when validating and applying a prediction model to new patients.","volume":"39","author":"J Hoogland","year":"2020","journal-title":"Stat Med"},{"key":"pgph.0003050.ref030","doi-asserted-by":"crossref","first-page":"e0002173","DOI":"10.1371\/journal.pgph.0002173","article-title":"Transitions from hospital to home: A mixed methods study to evaluate pediatric discharges in Uganda.","volume":"3","author":"O Kabajaasi","year":"2023","journal-title":"PLOS Glob public Heal."},{"key":"pgph.0003050.ref031","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1186\/s12916-019-1425-3","article-title":"Three myths about risk thresholds for prediction models.","volume":"17","author":"L Wynants","year":"2019","journal-title":"BMC Med"},{"key":"pgph.0003050.ref032","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/ckj\/sfaa188","article-title":"External validation of prognostic models: what, why, how, when and where?","volume":"14","author":"CL Ramspek","year":"2020","journal-title":"Clin Kidney J"},{"key":"pgph.0003050.ref033","doi-asserted-by":"crossref","first-page":"e37685","DOI":"10.2196\/37685","article-title":"The Need to Prioritize Model-Updating Processes in Clinical Artificial Intelligence (AI) Models: Protocol for a Scoping Review.","volume":"12","author":"AU Otokiti","year":"2023","journal-title":"JMIR Res Protoc."},{"key":"pgph.0003050.ref034","doi-asserted-by":"crossref","first-page":"103611","DOI":"10.1016\/j.jbi.2020.103611","article-title":"Detection of calibration drift in clinical prediction models to inform model updating.","volume":"112","author":"SE Davis","year":"2020","journal-title":"J Biomed Inform"},{"key":"pgph.0003050.ref035","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/23288604.2019.1583040","article-title":"Digital Technology and the Future of Health Systems.","volume":"5","author":"M Mitchell","year":"2019","journal-title":"Heal Syst Reform."},{"key":"pgph.0003050.ref036","doi-asserted-by":"crossref","first-page":"e100253","DOI":"10.1136\/bmjhci-2020-100253","article-title":"Adoption of clinical risk prediction tools is limited by a lack of integration with electronic health records","volume":"28","author":"V Sharma","year":"2021","journal-title":"BMJ Heal Care Informatics"},{"key":"pgph.0003050.ref037","article-title":"The world\u2019s largest health information management system\u2014developed through global collaboration led by UiO.","author":"University of Oslo","journal-title":"dhis2"},{"key":"pgph.0003050.ref038","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s13690-023-01116-0","article-title":"Successes, weaknesses, and recommendations to strengthen primary health care: a scoping review.","volume":"81","author":"A Endalamaw","year":"2023","journal-title":"Arch Public Health"},{"key":"pgph.0003050.ref039","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1038\/s41746-021-00487-4","article-title":"The potential use of digital health technologies in the African context: a systematic review of evidence from Ethiopia.","volume":"4","author":"T Manyazewal","year":"2021","journal-title":"NPJ Digit Med"},{"key":"pgph.0003050.ref040","unstructured":"ClinicalTrials.gov. Smart Discharges to Improve Post-discharge Health Outcomes in Children. In: NCT05730452 [Internet]. 2023 [cited 5 Dec 2023]. Available: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT05730452."},{"key":"pgph.0003050.ref041","doi-asserted-by":"crossref","first-page":"e20180606","DOI":"10.1542\/peds.2018-0606","article-title":"Postdischarge Mortality Prediction in Sub-Saharan Africa","volume":"143","author":"L Madrid","year":"2019","journal-title":"Pediatrics"},{"key":"pgph.0003050.ref042","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/ppe.12348","article-title":"Mortality after Inpatient Treatment for Severe Pneumonia in Children: a Cohort Study.","volume":"31","author":"MM Ngari","year":"2017","journal-title":"Paediatr Perinat Epidemiol"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0003050","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T13:25:08Z","timestamp":1714397108000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0003050"}},"subtitle":[],"editor":[{"given":"Collins Otieno","family":"Asweto","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,4,29]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0003050","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2023.06.14.23291343","asserted-by":"object"}]},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,29]]}}}