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Comparison of predictive models for postoperative nausea and vomiting
C C Apfel1, P Kranke, L H J Eberhart
1Department of Anaesthesiology, Julius Maximilians University, Würzburg, Germany.
British Journal of Anaesthesia
|March 9, 2002
Summary
Simplified risk scores for postoperative nausea and vomiting (PONV) showed better accuracy and practicality. These scores are recommended for clinical antiemetic strategies and trial comparisons.
Area of Science:
- Anesthesiology
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Postoperative nausea and vomiting (PONV) is a common adverse event.
- Several predictive models exist for assessing PONV risk.
- Identifying patients who benefit from prophylactic antiemetics is crucial.
Purpose of the Study:
- To compare the validity and practicability of six established PONV predictive models.
- To determine the most effective model for guiding antiemetic prophylaxis.
Main Methods:
- Analysis of data from 1566 patients undergoing general anesthesia without prophylactic antiemetics.
- Systematic literature search to identify six PONV predictive models.
- Comparison based on discriminating power (AUC) and calibration, and practicability (number of factors).
Main Results:
- The overall incidence of PONV was 38.1%.
- Simplified risk scores demonstrated superior discriminating power (AUC) and calibration compared to complex models.
- Models with fewer parameters (e.g., Apfel) showed better performance.
Conclusions:
- Simplified risk scores offer better discrimination and calibration for PONV prediction.
- These simplified models are recommended for clinical antiemetic strategies.
- They are also suitable for group comparisons in randomized controlled trials.