Applicability of risk scores for postoperative nausea and vomiting in adults to paediatric patients
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Published on: June 21, 2024
L H J Eberhart1, A M Morin, D Guber
1Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany. eberhart@mailer.uni-marburg.de
Insights
Existing adult risk scores are not effective for predicting postoperative vomiting in children. New, specialized pediatric scores are needed, potentially incorporating factors like anesthesia duration and opioid use.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Clinical Risk Prediction
Background:
- Established risk scores for postoperative vomiting (PV) and postoperative nausea and vomiting (PONV) exist for adult patients.
- These scores have not been adequately validated for pediatric populations.
Purpose of the Study:
- To assess the applicability and predictive accuracy of existing adult risk scores for PV in pediatric patients.
- To determine if current adult models can be reliably used in children aged 0-12 years undergoing surgery.
Main Methods:
- Evaluated five established risk prediction models in a cohort of 983 pediatric patients.
- Assessed model performance using discriminating power (Area Under the ROC Curve) and calibration (Weighed Linear Regression).
Main Results:
- The cumulative incidence of PV within 24 hours was 33.2%.
- All tested models demonstrated low and insufficient discriminating power (AUC 0.56-0.65).
- Predicted incidences from the scores showed poor correlation with observed actual incidences in children.
Conclusions:
- Current adult-based risk scores are inadequate for predicting PV in pediatric patients.
- Development of specialized pediatric risk scores is necessary.
- Potential independent risk factors for pediatric PV include history of PV, strabismus surgery, anesthesia duration ≥45 min, age ≥5 years, and postoperative opioid administration.
Background:
Scores to predict the occurrence of postoperative vomiting (PV) or nausea and vomiting (PONV) are well established in adult patients. The aim of this survey was to evaluate the applicability of risk scores developed and tested in adult patients in 983 paediatric patients (0-12 yr) undergoing various surgical procedures.
Method:
The predictive properties of five models were compared with respect to discriminating power (measured by the area under a receiver operating characteristic curve) and calibration (comparison of the predicted and the actual incidences of the disease by weighed linear regression analysis).
Results:
The cumulative incidence of PV was 33.2% within 24 h. The discriminating power was low and insufficient in all models tested (0.56-0.65). Furthermore, the predicted incidences of the scores correlated only vaguely with the actual incidences observed.
Conclusion:
Specialized scores for children are required. These might use the history of PV, strabismus surgery, duration of anaesthesia > or =45 min, age > or =5 yr and administration of postoperative opioids as independent risk factors.
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