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The STBUR questionnaire for predicting perioperative respiratory adverse events in children at risk for
Alan R Tait1, Terri Voepel-Lewis, Robert Christensen
1Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI 48109, USA. atait@umich.edu
Insights
A new tool, STBUR, identifies children with sleep-disordered breathing (SDB) symptoms who are at risk for perioperative respiratory adverse events (PRAE). This simple questionnaire aids anesthesia providers in pre-operative risk assessment for better patient safety.
Area of Science:
- Pediatric Anesthesiology
- Sleep Medicine
- Respiratory Health
Background:
- Many children with sleep-disordered breathing (SDB) are undiagnosed due to lack of formal polysomnography (PSG).
- Undiagnosed SDB increases the risk of perioperative respiratory adverse events (PRAE) in children undergoing surgery.
Purpose of the Study:
- To develop a practical tool for identifying children with SDB symptoms at risk for PRAE.
- To create a screening method that is simple and clinically useful for anesthesia providers.
Main Methods:
- Parents of 337 children completed the Sleep-Related Breathing Disorder (SRBD) questionnaire.
- Prospective data collection on PRAE incidence and severity, including airway obstruction and laryngospasm.
- Principal component analysis identified key predictive symptoms for the STBUR tool.
Main Results:
- 9.5% of children had confirmed SDB via PSG; 26.7% showed SDB symptoms via the SRBD questionnaire.
- The STBUR tool, based on Snoring, Trouble Breathing, and Un-Refreshed symptoms, predicted PRAE.
- Presence of 3 STBUR symptoms increased PRAE likelihood threefold; all 5 symptoms increased it tenfold.
Conclusions:
- Children with SDB symptoms undergoing surgery are at heightened risk for PRAE.
- The STBUR questionnaire is a promising, simple tool for identifying at-risk children pre-operatively.
- Validation studies are recommended to confirm the STBUR questionnaire's diagnostic utility.
Background:
In the absence of formal polysomnography (PSG), many children with symptoms of sleep-disordered breathing (SDB) go unrecognized and thus may be at risk for perioperative respiratory adverse events (PRAE).
Objectives:
To develop a simple practical tool to identify children with symptoms consistent with SDB who may be at risk for PRAE.
Methods:
Three-hundred and thirty-seven parents of children scheduled for surgery completed the Sleep-Related Breathing Disorder (SRBD) questionnaire. Data regarding the incidence and severity of PRAE including airway obstruction and laryngospasm, were collected prospectively.
Results:
Thirty-two (9.5%) children had a confirmed diagnosis of SDB by PSG and 90 (26.7%) had symptoms consistent with SDB based on the SRBD questionnaire. Principal component analysis identified five symptoms from the SRBD questionnaire that were strongly predictive of PRAE and which were incorporated into the STBUR tool (Snoring, Trouble Breathing, Un-Refreshed). The likelihood of PRAE was increased by threefold (positive likelihood ratio 3.06 [1.64-5.96] in the presence of any 3 STBUR symptoms and by tenfold when all five symptoms were present (9.74 [1.35-201.8]). In comparison, the likelihood of PRAE based on a PSG-confirmed diagnosis of SDB was 2.63 (1.17-6.23).
Conclusions:
Children presenting for surgery with symptoms consistent with SDB may be at risk for PRAE. It is important therefore that anesthesia providers identify these individuals prior to surgery to avoid potential complications. The STBUR questionnaire appears promising as a simple, clinically useful tool for identifying children at risk for PRAE. Further studies to validate the STBUR questionnaire as a diagnostic tool may be warranted.
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