Predicting Mortality or Intestinal Failure in Infants with Surgical Necrotizing Enterocolitis - 23/11/17
, Curtis Travers, MPH 2, Ravi M. Patel, MD, MSc 1, Julia Shinnick, MD 3, Kelly Arps, MD 3, Sarah Keene, MD 1, Mehul V. Raval, MD, MS 3Abstract |
Objective |
To compare existing outcome prediction models and create a novel model to predict death or intestinal failure (IF) in infants with surgical necrotizing enterocolitis (NEC).
Study design |
A retrospective, observational cohort study conducted in a 2-campus health system in Atlanta, Georgia, from September 2009 to May 2015. Participants included all infants ≤37 weeks of gestation with surgical NEC. Logistic regression was used to model the probability of death or IF, as a composite outcome, using preoperative variables defined by specifications from 3 existing prediction models: American College of Surgeons National Surgical Quality Improvement Program Pediatric, Score for Neonatal Acute Physiology Perinatal Extension, and Vermont Oxford Risk Adjustment Tool. A novel preoperative hybrid prediction model was also derived and validated against a patient cohort from a separate campus.
Results |
Among 147 patients with surgical NEC, discrimination in predicting death or IF was greatest with American College of Surgeons National Surgical Quality Improvement Program Pediatric (area under the receiver operating characteristic curve [AUC], 0.84; 95% CI, 0.77-0.91) when compared with the Score for Neonatal Acute Physiology Perinatal Extension II (AUC, 0.60; 95% CI, 0.48-0.72) and Vermont Oxford Risk Adjustment Tool (AUC, 0.74; 95% CI, 0.65-0.83). A hybrid model was developed using 4 preoperative variables: the 1-minute Apgar score, inotrope use, mean blood pressure, and sepsis. The hybrid model AUC was 0.85 (95% CI, 0.78-0.92) in the derivation cohort and 0.77 (95% CI, 0.66-0.86) in the validation cohort.
Conclusions |
Preoperative prediction of death or IF among infants with surgical NEC is possible using existing prediction tools and, to a greater extent, using a newly proposed 4-variable hybrid model.
Le texte complet de cet article est disponible en PDF.Keywords : Vermont Oxford Network Risk Adjusted Model, SNAPPE-II, Score for Neonatal Acute Physiology Perinatal Extension* Version II, NSQIP-P, The American College of Surgeons' National Surgical Quality Improvement Program - Pediatric, AUC, Area Under the Receiver Operating Curve, Infection, Neonatal
Abbreviations : AUC, H-L, IF, NEC, NSQIP-P, SIP, SNAPPE-II, VON-RA
Plan
| R.P receives support from the National Institutes of Health (NIH) (K23 HL128942). M.R. is supported by the Emory University Department of Surgery and the Emory Children's Pediatric Research Alliance. The other authors declare no conflicts of interest. |
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| Portions of this study were presented at the Pediatric Academic Societies in Baltimore, Maryland, April 30-May 3, 2016; the American Academy of Pediatrics National Conference & Exhibition in Chicago, Illinois, September 16-19, 2017; and the Southern Society for Pediatric Research Annual Meeting in New Orleans, Louisiana, February 18-20, 2017. |
Vol 191
P. 22 - décembre 2017 Retour au numéro
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