tetano
Editor, Senior Moderator
BMC Pediatr
. 2024 May 20;24(1):347.
doi: 10.1186/s12887-024-04773-4. Identification of neurological complications in childhood influenza: a random forest model
Suyun Li[SUP] #[/SUP][SUP] 1 [/SUP], Weiqiang Xiao[SUP] #[/SUP][SUP] 2 [/SUP], Huixian Li[SUP] #[/SUP][SUP] 3 [/SUP], Dandan Hu[SUP] 4 [/SUP], Kuanrong Li[SUP] 3 [/SUP], Qinglian Chen[SUP] 1 [/SUP], Guangming Liu[SUP] 1 [/SUP], Haomei Yang[SUP] 1 [/SUP], Yongling Song[SUP] 1 [/SUP], Qiuyan Peng[SUP] 1 [/SUP], Qiang Wang[SUP] 1 [/SUP], Shuyao Ning[SUP] 5 [/SUP], Yumei Xiong[SUP] 1 [/SUP], Wencheng Ma[SUP] 1 [/SUP], Jun Shen[SUP] 1 [/SUP], Kelu Zheng[SUP] 4 [/SUP], Yan Hong[SUP] 1 [/SUP], Sida Yang[SUP] 6 [/SUP], Peiqing Li[SUP] 7 [/SUP]
Affiliations
Background: Among the neurological complications of influenza in children, the most severe is acute necrotizing encephalopathy (ANE), with a high mortality rate and neurological sequelae. ANE is characterized by rapid progression to death within 1-2 days from onset. However, the knowledge about the early diagnosis of ANE is limited, which is often misdiagnosed as simple seizures/convulsions or mild acute influenza-associated encephalopathy (IAE).
Objective: To develop and validate an early prediction model to discriminate the ANE from two common neurological complications, seizures/convulsions and mild IAE in children with influenza.
Methods: This retrospective case-control study included patients with ANE (median age 3.8 (2.3,5.4) years), seizures/convulsions alone (median age 2.6 (1.7,4.3) years), or mild IAE (median age 2.8 (1.5,6.1) years) at a tertiary pediatric medical center in China between November 2012 to January 2020. The random forest algorithm was used to screen the characteristics and construct a prediction model.
Results: Of the 433 patients, 278 (64.2%) had seizures/convulsions alone, 106 (24.5%) had mild IAE, and 49 (11.3%) had ANE. The discrimination performance of the model was satisfactory, with an accuracy above 0.80 from both model development (84.2%) and internal validation (88.2%). Seizures/convulsions were less likely to be wrongly classified (3.7%, 2/54), but mild IAE (22.7%, 5/22) was prone to be misdiagnosed as seizures/convulsions, and a small proportion (4.5%, 1/22) of them was prone to be misdiagnosed as ANE. Of the children with ANE, 22.2% (2/9) were misdiagnosed as mild IAE, and none were misdiagnosed as seizures/convulsions.
Conclusion: This model can distinguish the ANE from seizures/convulsions with high accuracy and from mild IAE close to 80% accuracy, providing valuable information for the early management of children with influenza.
Keywords: Acute febrile; Acute necrotizing encephalopathy; Children; Complications; Encephalitis; Influenza; Predictive model.
. 2024 May 20;24(1):347.
doi: 10.1186/s12887-024-04773-4. Identification of neurological complications in childhood influenza: a random forest model
Suyun Li[SUP] #[/SUP][SUP] 1 [/SUP], Weiqiang Xiao[SUP] #[/SUP][SUP] 2 [/SUP], Huixian Li[SUP] #[/SUP][SUP] 3 [/SUP], Dandan Hu[SUP] 4 [/SUP], Kuanrong Li[SUP] 3 [/SUP], Qinglian Chen[SUP] 1 [/SUP], Guangming Liu[SUP] 1 [/SUP], Haomei Yang[SUP] 1 [/SUP], Yongling Song[SUP] 1 [/SUP], Qiuyan Peng[SUP] 1 [/SUP], Qiang Wang[SUP] 1 [/SUP], Shuyao Ning[SUP] 5 [/SUP], Yumei Xiong[SUP] 1 [/SUP], Wencheng Ma[SUP] 1 [/SUP], Jun Shen[SUP] 1 [/SUP], Kelu Zheng[SUP] 4 [/SUP], Yan Hong[SUP] 1 [/SUP], Sida Yang[SUP] 6 [/SUP], Peiqing Li[SUP] 7 [/SUP]
Affiliations
- PMID: 38769496
- DOI: 10.1186/s12887-024-04773-4
Background: Among the neurological complications of influenza in children, the most severe is acute necrotizing encephalopathy (ANE), with a high mortality rate and neurological sequelae. ANE is characterized by rapid progression to death within 1-2 days from onset. However, the knowledge about the early diagnosis of ANE is limited, which is often misdiagnosed as simple seizures/convulsions or mild acute influenza-associated encephalopathy (IAE).
Objective: To develop and validate an early prediction model to discriminate the ANE from two common neurological complications, seizures/convulsions and mild IAE in children with influenza.
Methods: This retrospective case-control study included patients with ANE (median age 3.8 (2.3,5.4) years), seizures/convulsions alone (median age 2.6 (1.7,4.3) years), or mild IAE (median age 2.8 (1.5,6.1) years) at a tertiary pediatric medical center in China between November 2012 to January 2020. The random forest algorithm was used to screen the characteristics and construct a prediction model.
Results: Of the 433 patients, 278 (64.2%) had seizures/convulsions alone, 106 (24.5%) had mild IAE, and 49 (11.3%) had ANE. The discrimination performance of the model was satisfactory, with an accuracy above 0.80 from both model development (84.2%) and internal validation (88.2%). Seizures/convulsions were less likely to be wrongly classified (3.7%, 2/54), but mild IAE (22.7%, 5/22) was prone to be misdiagnosed as seizures/convulsions, and a small proportion (4.5%, 1/22) of them was prone to be misdiagnosed as ANE. Of the children with ANE, 22.2% (2/9) were misdiagnosed as mild IAE, and none were misdiagnosed as seizures/convulsions.
Conclusion: This model can distinguish the ANE from seizures/convulsions with high accuracy and from mild IAE close to 80% accuracy, providing valuable information for the early management of children with influenza.
Keywords: Acute febrile; Acute necrotizing encephalopathy; Children; Complications; Encephalitis; Influenza; Predictive model.