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. 2024 Mar 1;229(Supplement_1):S8-S17.
doi: 10.1093/infdis/jiad436.

Validity of Clinical Severity Scores for Respiratory Syncytial Virus: A Systematic Review

Zakariya Sheikh  1 , Ellie Potter  1 , You Li  2 , Rachel A Cohen  3 , Gaël Dos Santos  4 , Louis Bont  5 , Harish Nair  2   6   7 ; PROMISE Investigators
Collaborators, Affiliations

Validity of Clinical Severity Scores for Respiratory Syncytial Virus: A Systematic Review

Zakariya Sheikh et al. J Infect Dis. .

Abstract

Background: Respiratory syncytial virus (RSV) is a widespread respiratory pathogen, and RSV-related acute lower respiratory tract infections are the most common cause of respiratory hospitalization in children <2 years of age. Over the last 2 decades, a number of severity scores have been proposed to quantify disease severity for RSV in children, yet there remains no overall consensus on the most clinically useful score.

Methods: We conducted a systematic review of English-language publications in peer-reviewed journals published since January 2000 assessing the validity of severity scores for children (≤24 months of age) with RSV and/or bronchiolitis, and identified the most promising scores. For included articles, (1) validity data were extracted, (2) quality of reporting was assessed using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis checklist (TRIPOD), and (3) quality was assessed using the Prediction Model Risk Of Bias Assessment Tool (PROBAST). To guide the assessment of the validity data, standardized cutoffs were employed, and an explicit definition of what we required to determine a score was sufficiently validated.

Results: Our searches identified 8541 results, of which 1779 were excluded as duplicates. After title and abstract screening, 6670 references were excluded. Following full-text screening and snowballing, 32 articles, including 31 scores, were included. The most frequently assessed scores were the modified Tal score and the Wang Bronchiolitis Severity Score; none of the scores were found to be sufficiently validated according to our definition. The reporting and/or design of all the included studies was poor. The best validated score was the Bronchiolitis Score of Sant Joan de Déu, and a number of other promising scores were identified.

Conclusions: No scores were found to be sufficiently validated. Further work is warranted to validate the existing scores, ideally in much larger datasets.

Keywords: RSV; severity score; systematic review; validity.

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Conflict of interest statement

Potential conflicts of interest. Y. L. has received funding from the Wellcome Trust and GSK, outside the submitted work; and has received consulting fees from Pfizer. R. A. C. is an employee of the GSK group of companies, holds shares in the GSK group of companies, and has received other compensation from GSK, outside the submitted work; has received support from Westat (former employer) for attending meetings/travel; and has held stock or stock options from Westat. G. D. S. is an employee of the GSK group of companies and hold shares as part of his annual remunerations. L. B. has received funding through University Medical Center Utrecht from AbbVie, Janssen, the Bill & Melinda Gates Foundation, Nutricia Danon, MeMed Diagnostics, GSK, Novavax, AstraZeneca, Sanofi, Ablynx, Bavaria Nordic, MabXience, Novavax, and Pfizer. H. N. has received funding from the Innovative Medicines Initiative (IMI) (grant to institution), the National Institute for Health and Care Research, Icosavax, and Pfizer; has received consulting fees from the World Health Organization (WHO), Pfizer, the Bill & Melinda Gates Foundation, and Sanofi; has received honoraria from AbbVie for educational events; has received support for attending meetings/travel from Sanofi; and has served on a data and safety monitoring board or advisory board for GSK, Sanofi, Merck, WHO, Janssen, Novavax, ReSVinet, Icosavax, and Pfizer. Z. S. has received support for attending meetings/travel from PROMISE/IMI to attend the PROMISE AGM and 12th International RSV Symposium; and is a shareholder of Evidence-Based Health Care Ltd. E. P. reports no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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