Descriptive data of the development and validation cohort.

Descriptive data of the development and validation cohort.</p

Area under receiver operating characteristic curve (AUC) for each score for predicting mortality in the development cohort.

Area under receiver operating characteristic curve (AUC) for each score for predicting mortality in the development cohort.</p

Bar charts of LqSOFA, BqSOFA and FEAST-PET in the validation cohort.

Bar charts of LqSOFA, BqSOFA and FEAST-PET in the validation cohort.</p

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Table A: Inclusion criteria of the development and validation cohorts Table B: Components of the LqSOFA Table C: Cut-off values for heart and respiratory rate in different guidelines Table D: Components of the FEAST-PET Table E: Components of the BqSOFA Table F: Univariate analysis of (possible) predictors for in-hospital mortality in the development cohort Table G: Stepwise approach amending the LqSOFA to develop the BqSOFA Table H: BqSOFA compared to FEAST-PET (Net Reclassification Index) Fig A: Flow diagram included children in development and validation cohort Fig B: Comparison of cut-off values for heart rate and respiratory rate in different guidelines and studies (DOCX)</p

Prognostic performance of LqSOFA, BqSOFA and FEAST-PET score in development cohort.

Prognostic performance of LqSOFA, BqSOFA and FEAST-PET score in development cohort.</p

Bar charts of LqSOFA, BqSOFA and FEAST-PET in the development cohort.

Bar charts of LqSOFA, BqSOFA and FEAST-PET in the development cohort.</p

Prognostic performance of LqSOFA, BqSOFA and FEAST-PET in the validation cohort.

Prognostic performance of LqSOFA, BqSOFA and FEAST-PET in the validation cohort.</p

Area under receiver operating characteristic curve (AUC) for each score for predicting mortality in the validation cohort.

Area under receiver operating characteristic curve (AUC) for each score for predicting mortality in the validation cohort.</p

Inclusivity in global research.

In low-resource settings, a reliable bedside score for timely identification of children at risk of dying, could help focus resources and improve survival. The rapid bedside Liverpool quick Sequential Organ Failure Assessment (LqSOFA) uses clinical parameters only and performed well in United Kingdom cohorts. A similarly quick clinical assessment-only score has however not yet been developed for paediatric populations in sub-Saharan Africa. In a development cohort of critically ill children in Malawi, we calculated the LqSOFA scores using age-adjusted heart rate and respiratory rate, capillary refill time and Blantyre Coma Scale, and evaluated its prognostic performance for mortality. An improved score, the Blantyre qSOFA (BqSOFA), was developed (omitting heart rate, adjusting respiratory rate cut-off values and adding pallor), subsequently validated in a second cohort of Malawian children, and compared with an existing score (FEAST-PET). Prognostic performance for mortality was evaluated using area under the receiver operating characteristic curve (AUC). Mortality was 15.4% in the development (N = 493) and 22.0% in the validation cohort (N = 377). In the development cohort, discriminative ability (AUC) of the LqSOFA to predict mortality was 0.68 (95%-CI: 0.60–0.76). The BqSOFA and FEAST-PET yielded AUCs of 0.84 (95%-CI:0.79–0.89) and 0.83 (95%-CI:0.77–0.89) in the development cohort, and 0.74 (95%-CI:0.68–0.79) and 0.76 (95%-CI:0.70–0.82) in the validation cohort, respectively. We developed a simple prognostic score for Malawian children based on four clinical parameters which performed as well as a more complex score. The BqSOFA might be used to promptly identify critically ill children at risk of dying and prioritize hospital care in low-resource settings.</div