{"id":"https://openalex.org/W7204495705","doi":"https://doi.org/10.21203/rs.3.rs-10449714/v1","title":"Application of Fine\u2013Gray Competing Risk Modeling to Predict Pediatric Care Escalation Pathways in Southeast Ethiopia","display_name":"Application of Fine\u2013Gray Competing Risk Modeling to Predict Pediatric Care Escalation Pathways in Southeast Ethiopia","publication_year":2026,"publication_date":"2026-08-28","ids":{"openalex":"https://openalex.org/W7204495705","doi":"https://doi.org/10.21203/rs.3.rs-10449714/v1"},"language":"en","primary_location":{"id":"doi:10.21203/rs.3.rs-10449714/v1","doi":"https://doi.org/10.21203/rs.3.rs-10449714/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-10449714/v1","pdf_url":"https://www.researchsquare.com/article/rs-10449714/latest.pdf","source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.researchsquare.com/article/rs-10449714/latest.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5004022779","display_name":"Ayalneh Demissie","orcid":"https://orcid.org/0000-0001-7240-7238","observed_orcids":["https://orcid.org/0000-0001-7240-7238"]},"institutions":[{"id":"https://openalex.org/I4400600922","display_name":"Arsi University","ror":"https://ror.org/04s6kmw55","country_code":"ET","type":"education","lineage":["https://openalex.org/I4400600922"]}],"countries":["ET"],"is_corresponding":true,"raw_author_name":"Ayalneh Demissie","raw_affiliation_strings":["Arsi University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Arsi University","institution_ids":["https://openalex.org/I4400600922"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5126799216","display_name":"Tufa Nugusu","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4400600922","display_name":"Arsi University","ror":"https://ror.org/04s6kmw55","country_code":"ET","type":"education","lineage":["https://openalex.org/I4400600922"]}],"countries":["ET"],"is_corresponding":false,"raw_author_name":"Tufa Nugusu","raw_affiliation_strings":["Arsi University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Arsi University","institution_ids":["https://openalex.org/I4400600922"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5093771696","display_name":"Helen Bekele","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I865572129","display_name":"Adama Science and Technology University","ror":"https://ror.org/02ccba128","country_code":"ET","type":"education","lineage":["https://openalex.org/I865572129"]}],"countries":["ET"],"is_corresponding":false,"raw_author_name":"Helen Bekele","raw_affiliation_strings":["Adama Science and Technology University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Adama Science and Technology University","institution_ids":["https://openalex.org/I865572129"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5126797401","display_name":"Achalu Mekuria","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4400600922","display_name":"Arsi University","ror":"https://ror.org/04s6kmw55","country_code":"ET","type":"education","lineage":["https://openalex.org/I4400600922"]}],"countries":["ET"],"is_corresponding":false,"raw_author_name":"Achalu Mekuria","raw_affiliation_strings":["Arsi University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Arsi University","institution_ids":["https://openalex.org/I4400600922"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5126797214","display_name":"Tesfa Gebremeskel","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4400600922","display_name":"Arsi University","ror":"https://ror.org/04s6kmw55","country_code":"ET","type":"education","lineage":["https://openalex.org/I4400600922"]}],"countries":["ET"],"is_corresponding":false,"raw_author_name":"Tesfa Gebremeskel","raw_affiliation_strings":["Arsi University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Arsi University","institution_ids":["https://openalex.org/I4400600922"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5106949156","display_name":"Addis Wordofa","orcid":"https://orcid.org/0000-0002-1010-7931","observed_orcids":["https://orcid.org/0000-0002-1010-7931"]},"institutions":[{"id":"https://openalex.org/I4400600922","display_name":"Arsi University","ror":"https://ror.org/04s6kmw55","country_code":"ET","type":"education","lineage":["https://openalex.org/I4400600922"]}],"countries":["ET"],"is_corresponding":false,"raw_author_name":"Addis Wordofa","raw_affiliation_strings":["Arsi University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Arsi University","institution_ids":["https://openalex.org/I4400600922"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5004022779"],"corresponding_institution_ids":["https://openalex.org/I4400600922"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11467","display_name":"Trauma and Emergency Care Studies","score":0.2168000042438507,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11467","display_name":"Trauma and Emergency Care Studies","score":0.2168000042438507,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10209","display_name":"Global Maternal and Child Health","score":0.2013999968767166,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10218","display_name":"Sepsis Diagnosis and Treatment","score":0.18700000643730164,"subfield":{"id":"https://openalex.org/subfields/2706","display_name":"Critical Care and Intensive Care Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/pediatric-emergency-care","display_name":"pediatric emergency care","score":0.9139999747276306},{"id":"https://openalex.org/keywords/treatment-escalation","display_name":"treatment escalation","score":0.8840000033378601},{"id":"https://openalex.org/keywords/competing-risks","display_name":"competing risks","score":0.6320000290870667},{"id":"https://openalex.org/keywords/in-hospital-mortality","display_name":"in-hospital mortality","score":0.8730000257492065},{"id":"https://openalex.org/keywords/malnutrition","display_name":"malnutrition","score":0.5889999866485596},{"id":"https://openalex.org/keywords/clinical-risk-score","display_name":"clinical risk score","score":0.7889999747276306},{"id":"https://openalex.org/keywords/triage","display_name":"triage","score":0.5879999995231628},{"id":"https://openalex.org/keywords/resource-limited-settings","display_name":"resource-limited settings","score":0.6129999756813049},{"id":"https://openalex.org/keywords/child-mortality","display_name":"child mortality","score":0.6100000143051147},{"id":"https://openalex.org/keywords/delayed-presentation","display_name":"delayed presentation","score":0.5239999890327454},{"id":"https://openalex.org/keywords/altered-mental-status","display_name":"altered mental status","score":0.7319999933242798},{"id":"https://openalex.org/keywords/pre-existing-comorbidities","display_name":"pre-existing comorbidities","score":0.8820000290870667},{"id":"https://openalex.org/keywords/southeast-ethiopia","display_name":"Southeast Ethiopia","score":0.5879999995231628},{"id":"https://openalex.org/keywords/risk-stratification","display_name":"risk stratification","score":0.5929999947547913},{"id":"https://openalex.org/keywords/cumulative-incidence-function","display_name":"cumulative incidence function","score":0.5720000267028809},{"id":"https://openalex.org/keywords/time-dependent-roc-curve","display_name":"time-dependent ROC curve","score":0.5059999823570251},{"id":"https://openalex.org/keywords/delong-test","display_name":"DeLong test","score":0.6370000243186951}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.7893999814987183},{"id":"https://openalex.org/C2776135927","wikidata":"https://www.wikidata.org/wiki/Q5242559","display_name":"Referral","level":2,"score":0.6401000022888184},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.5357000231742859},{"id":"https://openalex.org/C12174686","wikidata":"https://www.wikidata.org/wiki/Q1058438","display_name":"Risk assessment","level":2,"score":0.45190000534057617},{"id":"https://openalex.org/C61511704","wikidata":"https://www.wikidata.org/wiki/Q1671857","display_name":"Incidence (geometry)","level":2,"score":0.42399999499320984},{"id":"https://openalex.org/C50382708","wikidata":"https://www.wikidata.org/wiki/Q223218","display_name":"Proportional hazards model","level":2,"score":0.4131999909877777},{"id":"https://openalex.org/C2987404301","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care","level":2,"score":0.4059999883174896},{"id":"https://openalex.org/C88879693","wikidata":"https://www.wikidata.org/wiki/Q217690","display_name":"Cumulative incidence","level":3,"score":0.3939000070095062},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.3919000029563904},{"id":"https://openalex.org/C2777984932","wikidata":"https://www.wikidata.org/wiki/Q7336293","display_name":"Risk of mortality","level":2,"score":0.38429999351501465},{"id":"https://openalex.org/C2777120189","wikidata":"https://www.wikidata.org/wiki/Q780067","display_name":"Triage","level":2,"score":0.3634999990463257},{"id":"https://openalex.org/C2780724011","wikidata":"https://www.wikidata.org/wiki/Q1295316","display_name":"Emergency department","level":2,"score":0.35910001397132874},{"id":"https://openalex.org/C3020404979","wikidata":"https://www.wikidata.org/wiki/Q1058438","display_name":"Risk stratification","level":2,"score":0.3571000099182129},{"id":"https://openalex.org/C2779159551","wikidata":"https://www.wikidata.org/wiki/Q1414874","display_name":"Comorbidity","level":2,"score":0.3447999954223633},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.3379000127315521},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.33559998869895935},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.32690000534057617},{"id":"https://openalex.org/C2775909303","wikidata":"https://www.wikidata.org/wiki/Q3259564","display_name":"Inpatient care","level":3,"score":0.3172000050544739},{"id":"https://openalex.org/C58471807","wikidata":"https://www.wikidata.org/wiki/Q327120","display_name":"Receiver operating characteristic","level":2,"score":0.3138999938964844},{"id":"https://openalex.org/C82789193","wikidata":"https://www.wikidata.org/wiki/Q2142611","display_name":"Relative risk","level":3,"score":0.31139999628067017},{"id":"https://openalex.org/C30036603","wikidata":"https://www.wikidata.org/wiki/Q17125150","display_name":"Severity of illness","level":2,"score":0.2919999957084656},{"id":"https://openalex.org/C17923572","wikidata":"https://www.wikidata.org/wiki/Q7250160","display_name":"Propensity score matching","level":2,"score":0.2897000014781952},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.2872999906539917},{"id":"https://openalex.org/C2776056953","wikidata":"https://www.wikidata.org/wiki/Q1182511","display_name":"De-escalation","level":2,"score":0.287200003862381},{"id":"https://openalex.org/C49261128","wikidata":"https://www.wikidata.org/wiki/Q1132455","display_name":"Hazard","level":2,"score":0.27900001406669617},{"id":"https://openalex.org/C534262118","wikidata":"https://www.wikidata.org/wiki/Q177719","display_name":"Medical diagnosis","level":2,"score":0.2734000086784363},{"id":"https://openalex.org/C152877465","wikidata":"https://www.wikidata.org/wiki/Q208042","display_name":"Regression analysis","level":2,"score":0.27000001072883606},{"id":"https://openalex.org/C179755657","wikidata":"https://www.wikidata.org/wiki/Q58702","display_name":"Mortality rate","level":2,"score":0.2687999904155731},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.26339998841285706},{"id":"https://openalex.org/C2777601897","wikidata":"https://www.wikidata.org/wiki/Q3409113","display_name":"Presentation (obstetrics)","level":2,"score":0.2623000144958496},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.26019999384880066},{"id":"https://openalex.org/C49453240","wikidata":"https://www.wikidata.org/wiki/Q1592163","display_name":"Construct validity","level":3,"score":0.2597000002861023},{"id":"https://openalex.org/C107130276","wikidata":"https://www.wikidata.org/wiki/Q133805","display_name":"Epidemiology","level":2,"score":0.25920000672340393},{"id":"https://openalex.org/C207103383","wikidata":"https://www.wikidata.org/wiki/Q3930246","display_name":"Hazard ratio","level":3,"score":0.2563000023365021},{"id":"https://openalex.org/C50440223","wikidata":"https://www.wikidata.org/wiki/Q1475848","display_name":"Risk factor","level":2,"score":0.25049999356269836}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.21203/rs.3.rs-10449714/v1","doi":"https://doi.org/10.21203/rs.3.rs-10449714/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-10449714/v1","pdf_url":"https://www.researchsquare.com/article/rs-10449714/latest.pdf","source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.21203/rs.3.rs-10449714/v1","doi":"https://doi.org/10.21203/rs.3.rs-10449714/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-10449714/v1","pdf_url":"https://www.researchsquare.com/article/rs-10449714/latest.pdf","source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":1.0,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7204495705.pdf","grobid_xml":"https://content.openalex.org/works/W7204495705.grobid-xml"},"referenced_works_count":17,"referenced_works":["https://openalex.org/W1977247044","https://openalex.org/W1994682257","https://openalex.org/W2019694480","https://openalex.org/W2038981426","https://openalex.org/W2115709314","https://openalex.org/W2155069705","https://openalex.org/W2297716127","https://openalex.org/W2328176404","https://openalex.org/W2754160328","https://openalex.org/W3012413426","https://openalex.org/W3158873457","https://openalex.org/W4394611629","https://openalex.org/W4396799227","https://openalex.org/W4399086815","https://openalex.org/W4403967915","https://openalex.org/W4407402971","https://openalex.org/W4414553601"],"related_works":["https://openalex.org/W7131392349","https://openalex.org/W4294876973","https://openalex.org/W6939504698","https://openalex.org/W4366742176","https://openalex.org/W4296753454","https://openalex.org/W7169731169","https://openalex.org/W4410108526","https://openalex.org/W6921016618","https://openalex.org/W7140093931","https://openalex.org/W3044660721"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Pediatric":[2],"emergency":[3,142,194],"conditions":[4],"remain":[5],"a":[6,27,61,102,114],"primary":[7,153,302],"driver":[8],"of":[9,51,70,155,181,237,290,304],"preventable":[10],"childhood":[11],"mortality":[12,59,100,162],"in":[13,267],"low-resource":[14,268],"settings.":[15],"The":[16,222],"transition":[17],"from":[18],"initial":[19,285],"stabilization":[20],"to":[21,47,112,164],"escalated":[22],"care\u2014termed":[23],"the":[24,152,176,301],"\"Third":[25],"Delay\"\u2014is":[26],"critical":[28,298],"phase":[29],"where":[30],"dynamic":[31],"competing":[32,62,85,104],"risks":[33,63],"(such":[34],"as":[35,101,175],"early":[36,58],"in-hospital":[37,99,161],"mortality)":[38],"obscure":[39],"true":[40,103],"care":[41,52,156,182],"escalation":[42,53,183,266],"drivers.":[43],"This":[44],"study":[45,69],"aimed":[46],"identify":[48],"clinical":[49,117],"determinants":[50],"while":[54],"methodologically":[55],"accounting":[56],"for":[57],"using":[60],"framework.":[64],"Methods":[65],"A":[66],"retrospective":[67],"facility-based":[68],"407":[71,140],"pediatric":[72,141],"patients":[73],"(2022\u20132025)":[74],"was":[75,123],"conducted":[76],"at":[77,284],"Asella":[78],"Referral":[79],"and":[80,93,130,166,210,240,249,296],"Teaching":[81],"Hospital":[82],"(ARTH).":[83],"Fine\u2013Gray":[84],"risk":[86,118,253,282],"regression":[87],"estimated":[88],"Subdistribution":[89],"Hazard":[90],"Ratios":[91],"(asHR)":[92],"Cumulative":[94],"Incidence":[95],"Functions":[96],"(CIF),":[97],"treating":[98],"event.":[105],"Multivariable":[106],"\u03b2-coefficients":[107],"were":[108,146,169,219],"scaled":[109],"by":[110,273],"2":[111],"construct":[113],"simplified":[115],"bedside":[116],"score":[119,283],"(0\u201322":[120],"points).":[121],"Discrimination":[122],"validated":[124],"via":[125],"time-dependent":[126],"ROC":[127],"curve":[128,257],"analysis":[129],"DeLong's":[131],"test":[132,260],"comparing":[133],"continuous":[134],"vs.":[135],"integer":[136],"scores.":[137],"Results":[138],"Of":[139],"visits,":[143],"205":[144],"(50.4%)":[145],"discharged":[147],"improved,":[148],"185":[149],"(45.5%)":[150],"met":[151],"outcome":[154],"escalation,":[157,165],"9":[158],"(2.2%)":[159],"experienced":[160],"prior":[163],"6":[167],"(1.5%)":[168],"referred":[170],"out.":[171],"Baseline":[172],"malnutrition":[173],"emerged":[174],"single":[177],"strongest":[178],"independent":[179,220],"accelerator":[180],"(asHR":[184,196,201,207,216],"=":[185,197,202,208,217,228],"11.42;":[186],"95%":[187,230],"CI:":[188,231],"3.10\u201342.50;":[189],"p":[190,261],"<":[191,262],"0.001).":[192,263],"True":[193],"presentation":[195,212],"6.85),":[198],"pre-existing":[199],"comorbidity":[200],"6.50),":[203],"altered":[204],"mental":[205],"status":[206],"5.20),":[209],"delayed":[211],">":[213],"3":[214],"days":[215],"4.90)":[218],"predictors.":[221],"model":[223],"demonstrated":[224],"exceptional":[225],"discrimination":[226],"(AUC":[227],"0.88;":[229],"0.821\u20130.908)":[232],"with":[233],"an":[234,280],"optimal":[235],"threshold":[236],"85.0%":[238],"sensitivity":[239],"80.0%":[241],"specificity.":[242],"Stratification":[243],"into":[244],"Low":[245],"(0\u20134),":[246],"Moderate":[247],"(5\u20139),":[248],"High":[250],"(\u2265":[251,293],"10)":[252],"tiers":[254],"yielded":[255],"significant":[256],"divergence":[258],"(Gray\u2019s":[259],"Conclusion":[264],"Care":[265],"settings":[269],"is":[270],"heavily":[271],"driven":[272],"underlying":[274],"structural":[275],"vulnerabilities\u2014primarily":[276],"baseline":[277],"malnutrition.":[278],"Implementing":[279],"integer-based":[281],"triage":[286],"enables":[287],"rapid":[288],"identification":[289],"high-risk":[291],"children":[292],"10":[294],"points)":[295],"front-loads":[297],"monitoring":[299],"during":[300],"window":[303],"vulnerability.":[305]},"counts_by_year":[],"updated_date":"2026-11-12T12:28:57.059296","created_date":"2026-08-28T00:00:00"}
