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The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric
L H J Eberhart1, G Geldner, P Kranke
1*Department of Anesthesia and Intensive Care, Philipps-University, Marburg; †Department of Anesthesiology and Intensive Care, University of Würzburg, Würzburg; and ‡Ambulatory Surgical Center Söflingen, Ulm, Germany.
Insights
A new four-item risk score accurately predicts postoperative vomiting (PV) in children. This simplified score, the POVOC-score, identifies key risk factors for better pediatric PV prediction.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Pediatric Surgery
- Clinical Risk Prediction Modeling
Background:
- Existing risk scores for adult postoperative vomiting (PV) are unsuitable for children.
- Pediatric-specific risk factors for PV are not well-established.
- A validated, simple risk score for pediatric PV is needed.
Purpose of the Study:
- To develop and validate a simple, accurate risk score for predicting postoperative vomiting (PV) in children.
- To identify key preoperative risk factors for PV in pediatric surgical patients.
- To establish a tool for improved PV risk assessment in children undergoing surgery.
Main Methods:
- Development and validation of the POVOC-score using data from 1257 children (aged 0-14 years) across four institutions.
- Random split of data into evaluation (n=657) and validation (n=600) sets.
- Forward logistic regression for risk factor identification and ROC curve analysis for validation.
Main Results:
- Four independent risk factors for PV were identified: surgery duration ≥30 min, age ≥3 years, strabismus surgery, and a history of PV (personal or familial).
- PV incidence increased significantly with the number of risk factors (9% for 0 factors to 70% for 4 factors).
- The POVOC-score demonstrated acceptable predictive accuracy in the validation set, with an area under the ROC curve of 0.72 (95% CI: 0.68–0.77).
Conclusions:
- The developed POVOC-score is a simple and effective tool for predicting postoperative vomiting in pediatric patients.
- The score's identified risk factors provide valuable insights for preoperative assessment and risk stratification.
- This validated score can aid clinicians in managing and potentially preventing PV in children undergoing surgery.
Abstract:
Risk scores to predict the occurrence of postoperative vomiting (PV) or nausea and vomiting that were developed for adult patients do not fit for children, because several risk factors are difficult to assess or are usually not applicable in pediatric patients (e.g., smoking status). Thus, in the present study, we sought to develop and to validate a simple score to predict PV in children (POVOC-score). Development and validation of the new score was based on data from 4 independent institutions of 1257 children (aged 0-14 yr) undergoing various types of surgery under general anesthesia without antiemetic prophylaxis. Preoperatively, several potential risk factors were recorded. Postoperatively, the occurrence of PV was observed for up to 24 h. The dataset was randomly split into an evaluation set (n = 657) that was analyzed using a forward logistic regression technique and a validation set (n = 600) that was used to confirm the accuracy of prediction by means of the area under a receiver operating characteristic curve. Four independent risk factors for PV were identified in the final analysis: duration of surgery >/=30 min, age >/=3 yr, strabismus surgery, and a positive history of PV in the children or PV/postoperative nausea and vomiting in relatives (mother, father, or siblings). The incidence of PV was 9%, 10%, 30%, 55%, and 70% for 0, 1, 2, 3, and 4 risk factors observed. Using these incidences as cut-off values in the validation dataset, the area under the receiver operating characteristic curve was 0.72 (95% confidence interval: 0.68-0.77). Our data suggest that PV can be predicted with an acceptable accuracy using a four-item simplified risk score.