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Development and validation of a risk stratification index to predict death in gastroschisis
Meghan A Arnold1, David C Chang, Rosemary Nabaweesi
1Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Insights
A new risk stratification index for gastroschisis (a congenital anomaly) helps identify infants at highest risk of death. This tool improves upon existing systems for better patient outcomes.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Neonatal Care
Background:
- Gastroschisis is a rare congenital anomaly with over 90% survival due to improved surgical management.
- Accurate risk stratification is needed to identify high-risk infants and further improve outcomes.
Purpose of the Study:
- To develop and validate a novel risk stratification index for infants with gastroschisis.
- To identify key factors associated with mortality in gastroschisis.
Main Methods:
- Utilized the National Inpatient Sample and Kids' Inpatient Database (16 years).
- Identified infants with gastroschisis (ICD-9 code 54.71, age < 8 days).
- Logistic regression identified comorbidities associated with death; odds ratios created a weighted additive index, validated on 2003 KID data.
Main Results:
- Intestinal atresia, necrotizing enterocolitis, rare cardiac anomalies, and lung hypoplasia were strongly associated with death.
- A scoring system (0-10) was created based on these factors.
- Each point increase in the gastroschisis risk stratification index correlated with a 95% relative increase in mortality risk.
Conclusions:
- A novel, superior risk stratification index for gastroschisis has been developed.
- This index effectively identifies infants with gastroschisis at the highest risk of mortality.
- The findings can guide clinical management and resource allocation for high-risk neonates.
Background:
Gastroschisis is a rare congenital anomaly, the improved surgical management of which has contributed to a survival rate greater than 90%. Development of an accurate risk stratification system to help identify the subset of patients at greatest risk for death may lead to further improvements in outcome.
Methods:
Infants with gastroschisis were identified from 16 years of the National Inpatient Sample database and the Kids' Inpatient Database using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 54.71 (repair of gastroschisis) and an age of less than 8 days. Logistic regression analysis determined which coexisting diagnoses were significantly associated with death. Odds ratios from the logistic regression model were simplified and used as weighting factors to create an additive index. The index was validated using the 2003 Kids' Inpatient Database data set.
Results:
Intestinal atresia, necrotizing enterocolitis, rare cardiac anomalies, and lung hypoplasia were strongly associated with death and used to create a scoring system with a potential range of 0 to 10. Every point increase on the scale of gastroschisis risk stratification index is associated with a 95% relative increase in the likelihood of death.
Conclusion:
We have developed a novel index, which is superior to previous classification systems in identifying patients with gastroschisis who are at highest risk for death.