Development of a clinical prediction score for recurrent wheezing following acute lower respiratory tract infection in children

doi:10.5409/wjcp.123752

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World Journal of Clinical Pediatrics

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2219-2808

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Pediatr. Dec 9, 2026; 15(4): 123752
Published online Dec 9, 2026. doi: 10.5409/wjcp.123752

Development of a clinical prediction score for recurrent wheezing following acute lower respiratory tract infection in children

Pandaree Dokkham, Thamonpan Kiatvitchukul, Kornthip Jeephet, Klaita Srisingh

Pandaree Dokkham, Thamonpan Kiatvitchukul, Klaita Srisingh, Department of Pediatrics, Naresuan University, Phitsanulok 65000, Thailand

Kornthip Jeephet, Research Center of the Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand

Author contributions: Dokkham P and Srisingh K designed the study, had full access to all study data and was responsible for the integrity of the data and the accuracy of the analysis; Srisingh K were responsible for developing the methodology, wrote the original draft, also confirmed that all authors met authorship criteria and was responsible for submitting the manuscript; Kiatvitchukul T, Jeephet K, and Srisingh K participated in the formal analysis and investigation; Srisingh K, Dokkham P, Kiatvitchukul T, and Jeephet K participated in the review and editing. All authors have read and approved the final manuscript.

AI contribution statement: Only the AI (ChatGPT) was used for language editing and grammar checking in the manuscript. This AI tool was not employed in any other part of the research or in the preparation process of the manuscript.

Supported by the Faculty of Medicine, Naresuan University, Phitsanulok, Thailand, No. MD2567E001.

Institutional review board statement: This study was performed in accordance with the Declaration of Helsinki. This human study was approved by Naresuan University Institutional Review Board (approval No. P3-0102/2566).

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from the corresponding author upon reasonable request.

Corresponding author: Klaita Srisingh, Associate Professor, Department of Pediatrics, Naresuan University, 99 Moo 9, Phitsanulok-Nakhonsawan Road, Thapho Subdistrict, Phitsanulok 65000, Thailand. klaitas@nu.ac.th

Received: May 29, 2026
Revised: July 11, 2026
Accepted: September 4, 2026
Published online: December 9, 2026
Processing time: 113 Days and 18.8 Hours

Abstract

BACKGROUND

Recurrent wheezing is a significant complication following acute lower respiratory tract infection (ALRTI) in children and is a known precursor to asthma development. Identifying high-risk children remains challenging, particularly in resource-limited settings.

AIM

To develop and evaluate a simplified clinical prediction score for recurrent wheezing following ALRTI in children.

METHODS

A retrospective cohort study was conducted at Naresuan University Hospital, Thailand, involving children under 15 years diagnosed with ALRTI from July 2020 to December 2021. Participants were followed for 12 months. Recurrent wheezing was defined as ≥ 2 physician-diagnosed episodes. Demographic, clinical, environmental, and laboratory variables were extracted from electronic medical records. Independent predictors were identified using multivariable logistic regression and used to construct a point-based clinical prediction score. Model performance was evaluated using discrimination, calibration, sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy.

RESULTS

Of 280 eligible children, 52 (18.6%) developed recurrent wheezing. Independent predictors included allergic rhinitis, first-degree family history of asthma, eosinophilia, history of multiple LRTIs (≥ 2 prior episodes), food/drug allergy, and thalassemia. A point-based score (0-9) stratified patients into low-, moderate-, and high-risk groups. The model demonstrated good discrimination (area under the receiver operating characteristic curve: 0.79; 95% confidence interval: 0.71-0.88) and adequate calibration. Sensitivity decreased across increasing risk categories (48.57% for low, 34.29% for moderate, and 17.14% for high-risk groups), whereas specificity increased (12.75%, 87.25%, and 100%, respectively). Positive predictive values were 16.04%, 48.0%, and 100%, and negative predictive values were 41.94%, 79.46%, and 77.86%.

CONCLUSION

This clinical prediction score, based on readily available clinical variables, provides a practical tool for early risk stratification of recurrent wheezing in children following ALRTI. External validation is required to ensure the model’s robustness before widespread clinical adoption.

Keywords: Asthma; Children; Respiratory tract infection; Wheezing; Acute lower respiratory tract infection

Core Tip: Recurrent wheezing is a common condition in children with lower respiratory tract infections. This retrospective cohort study developed a predictive tool to estimate the risk of recurrent episodes, aiming to support treatment planning and clinical monitoring, and to identify children at increased risk of developing asthma later in life.