National 10-year Cohort Study of Life-threatening Invasive Group A Streptococcal Infection in Children, 2013–2023
Bibliographic record
Abstract
BACKGROUND: Invasive group A streptococcal disease (iGAS) is an important cause of pediatric morbidity and mortality. We aimed to describe severe, life-threatening, iGAS cases to inform critical care services planning and identify potential opportunities for early intervention to prevent progression to death. METHODS: Retrospective, multicenter, national cohort study in Scotland investigating critically unwell iGAS cases ≤15 years old from October 01, 2013 to September 30, 2023. We included children and young people (CYP) who required advanced intensive care or died with iGAS as the primary cause of death. Information collected included demographics, Streptococcus pyogenes emm types, viral coinfections and clinical outcomes. RESULTS: Eighty-two cases of severe, life-threatening iGAS were identified, with 20 resulting in death. The annual iGAS pediatric intensive care unit (PICU) admission rate was 0.69/100,000 CYP, with a mean annual mortality rate of 0.22/100,000. iGAS PICU admissions dropped during 2020-2021, returned to baseline in 2021-2022, and then increased sharply in 2022-2023 without an increase in death rates. Across the cohort, the predominant emm type was type 1. In 9.8% of cases, GAS was identified using a nonculture molecular method (specific polymerase chain reaction or 16S rRNA sequencing). Prior primary or secondary care contact was sought by 9/20 (45%) of CYP who died; there was no significant association between time-to-care to PICU and illness severity or risk of death. Viral coinfections were common and associated with higher severity scores. CONCLUSION: We demonstrate a significant annual burden of severe, life-threatening iGAS at the national level. High rates of viral coinfections and care-seeking before PICU admission or death, suggest potential opportunities for intervention.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".