Validity of the Responses to Illness Severity Quantification (RISQ) Score in Assessing Illness Severity and Care Transitions in Hospitalized Children with Severe Acute Malnutrition

This study aimed to assess the accuracy of the Responses to Illness Severity Quantification (RISQ) score in determining illness severity and transitions in levels of care among hospitalized children with severe acute malnutrition (SAM). Inpatients aged 1-59 months were included in the study. The primary outcome measure was the patient's RISQ score, which is calculated by combining heart and respiratory rate, oxygen saturation, respiratory effort, oxygen use, temperature, and level of consciousness. The recruited states were hierarchically classified based on illness severity, with hospital mortality being the most severe state, followed by intensive care (ICU), care in stabilization phase (SP), care in rehabilitation phase (RP), and the lowest severity, survival at hospital discharge.

The study found-

• Enrollment of 903 children (mean age 14.6 months)

• Death of 7% of children. 

• The average RISQ scores during care in different phases were as follows: 3.5 in the ICU, 1.7 in the SP, and 1.5 in the RP.

• Mean scores and Hazard Ratios (HR) for a 3-point change in the score at transitions were: 

• ICU to death, 6.9 (HR 1.80); 

• SP to ICU, 2.8 (HR 2.00); 

• ICU to SP, 2.0 (HR 0.5); and 

• RP to discharge, 1.4 (HR 0.91).

This study demonstrates the ability of the RISQ score to differentiate care escalation or de-escalation and accurately reflect illness severity in hospitalized children with severe acute malnutrition (SAM). However, further research is necessary to test and validate its clinical applications before considering widespread implementation.

 Dale NM, Ashir GM, Maryah LB, et al. Evaluating the Validity of the 'Responses to Illness Severity Quantification' (RISQ) Score to Discriminate Illness Severity and Level of Care Transitions in Hospitalized Children with Severe Acute Malnutrition. The Journal of Pediatrics. 2023. DOI:https://doi.org/10.1016/j.jpeds.2023.113609