PONE-D-23-36484Derivation and validation of a model to predict treatment failure among under five children with severe community acquired pneumonia who are admitted at Debre Tabor specialized comprehensive hospitalPLOS ONE

Dear Dr. Agimas,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================Please address the reviewers' comments below. ==============================

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We look forward to receiving your revised manuscript.

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Mohammed Feyisso Shaka, MPH

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This paper is well-done, here is my comments

In the method section

Outcome of interest

Treatment failure (Yes, No)

Independent variables

Pulmonary tuberculosis, meningitis, diarrhea, HIV status, dehydration, plural infusion, anemia, hypoglycemia, measles, chest indrowing, previous history of SCAP, weight for age, status at admission, pertussis and pulse rate.

Comment

The independent variable better rearrange in theme like socio-demographic, health facility related factors, Individual related factors, …backward step-wise logistic regression analysis also follow this theme.

Reviewer #2: Comments to authors

Generally, this is an extensive, novel, and well written research. With the following very minor comments the research work is publishable.

Abstract:

Check the grammar

Write the objective of the research separately

Write the figures in to two digits

Introduction:

In this section, the authors should address the following points

What is the clinical importance of the research?

What is the gap of the previous research?

Methods:

Use the appropriate punctuation for line 123.

In line 159 please specify the figure.

What is the importance of accuracy by chance value?

Why you used a systematic random sampling?

Results:

Please include the table within the main manuscript

The model “P (SCAP treatment failure) = 1/e-(-2.67 +1.14 *HIV status yes +0.765* plural effusion (yes) +0.55 193 *anemia (yes) +0.647*measles (yes) +0.915*chest indrowing (yes) +1.07 *history of SCAP (yes) + 194 0.603*pulse rate (abnormal) (Table-3)” is not well written please revise it.

Why you report decision curve analysis?

Discussion:

If similar studies are available so far, please include additional comparisons.

In line 228, what does it mean 450?

What is the strength of the study?

How to compare the AUC with corresponding previous AUC findings?

What is your recommendations for researcher in the future?

Reviewer #3: The authors need to have a nomogram model to show how much is loss of accuracy from the original one. The authors need to improve the discussion and conclusion part. You may see comments on the attached file or detailed below.

Abstract:

One of the most important aims of prognostic study is to find out prognostic determinants of the outcome of interest, however, your conclusion of your study in the abstract lacks this important facets of a conclusion.

Introduction:

The authors should have exclusively searched whether there was a study conducted so far on SCAP in the Ethiopia. The authors deny there is no single study done on the topic, however, there was one study here I dropped the link: https://pubmed.ncbi.nlm.nih.gov/36791115/. The study predicted poor outcomes of SCAP; treatment failure (prognostic outcome in the current study) was one of the composite outcomes in that study. Therefore, the authors in the current study should state and should properly justify that the current study is unique from the previous study; however, this is a flaw

Methods:

What by mean: “A secondary analysis of the previous prospective follow-up study was used among children with 92 SCAP who were admitted to the Debre Tabor specialized hospital intensive care unit” ? is this prospective study? What makes prospective if you use previously collected data from the hospital. You need to correct this.

Results:

Your original model resulted an accuracy of AUC 77.14%, however, the AUC of the validated model is 77.19%. How this logically acceptable. You do validation for the sake of minimizing over optimistic results. Validation technique is the same as adjustment the same as avoiding crude result for generalization. Logically, original results are over optimistic compared to validated ones, however, yours is controversial. This requires careful correction in case it is editorial problem or else.

The purpose of conducting prediction studies is to develop an easy to use risk stratification tool at the end of the study. In your case a nomogram tool; this is very important to have it. However, developing risk stratification tool can result in the loss of accuracy because it is simplification technique. This means always there will be a loss of accuracy from the original models. Therefore, researchers expected to develop a nomogram model, which means need to show the accuracy of nomogram model, so that you will be able to compare the results with original ones.

To construct the nomogram, it is good to have pulse rate and hemoglobin/hematocrit level as they are without classifying as normal vs. abnormal for the purpose of proper use of nomogram tool in the future. Therefore, include these variables in the model as continuous keeping the natural occurrences of the variables for correct interpretation of the tool. In addition, the author should put examples how to interpret the tool for the audience.

Discussion and Conclusion:

The authors didn’t well discuss their results with study findings and evidences in the country (in Ethiopia) and global context. The conclusion is a single sentence only about accuracy issue of the model. This very bad not make appropriate conclusion about the main

findings of the study based on the objectives of the study. Therefore, careful attention should be given and a significant change should be made to improve aforementioned parts of the manuscript.

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Reviewer #1: Yes:  Esubalew Tesfahun

Reviewer #2: No

Reviewer #3: Yes:  Zelalem Alamrew Anteneh

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Attachments

Attachment

Submitted filename: reviewer comments.docx

PONE-D-23-36484R1Derivation and validation of a model to predict treatment failure among under five children with severe community acquired pneumonia who are admitted at Debre Tabor specialized comprehensive hospitalPLOS ONE

Dear Dr. Agimas,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jan 17 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Wen-Jun Tu

Academic Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: All my comments and suggesstion properly addressed, so that no addtional comments in this version.

Reviewer #3: Still, there are important issues to be addressed before acceptance for publication. I will attach my comments for each section of the manuscript to be revised.

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Reviewer #1: Yes:  Esubalew Tesfahun

Reviewer #3: Yes:  Zelalem Alamrew Anteneh

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: #Derivation and validation treatment failure.docx

Derivation and validation of a model to predict treatment failure among under five children with severe community acquired pneumonia who are admitted at Debre Tabor specialized comprehensive hospital

PONE-D-23-36484R2

Dear Dr. Agimas,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Wen-Jun Tu

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors addresed all my comments and concerns. No addtional comments and suggestion in this version.

Reviewer #3: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: Yes:  Esubalew Tesfahun

Reviewer #3: Yes:  Zelalem Alamrew Anteneh

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