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Development and validation of the pediatric risk estimate score for children using extracorporeal respiratory support
Ryan P Barbaro1,2, Philip S Boonstra3, Matthew L Paden4
1Department of Pediatrics, University of Michigan, 1500 East Medical Center Drive, Mott F-6790/Box 5243, Ann Arbor, MI, 48109, USA. barbaror@med.umich.edu.
Insights
A new score, Ped-RESCUERS, estimates in-hospital mortality risk for children needing respiratory extracorporeal membrane oxygenation (ECMO) support. This tool aids in predicting outcomes for critically ill pediatric patients requiring ECMO.
Area of Science:
- Pediatric critical care medicine
- Extracorporeal membrane oxygenation (ECMO) research
- Medical risk stratification
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support technology for critically ill children with respiratory failure.
- Accurate prediction of in-hospital mortality risk is crucial for managing pediatric patients on ECMO.
- Existing risk prediction tools may not fully capture the complexities of pediatric ECMO cases.
Purpose of the Study:
- To develop and validate the Pediatric Risk Estimation Score for Children Using Extracorporeal Respiratory Support (Ped-RESCUERS).
- Ped-RESCUERS aims to estimate the in-hospital mortality risk in pediatric patients before initiating respiratory ECMO.
- To provide a novel tool for assessing pre-ECMO mortality risk in children.
Main Methods:
- Utilized data from an international registry of pediatric patients (29 days to <18 years) who received ECMO from 2009-2014.
- Employed Bayesian logistic regression to identify independent predictors of in-hospital mortality (≥2% risk change).
- Assessed model discrimination using the area under the curve (AUC) of the receiver operating characteristic curve.
Main Results:
- The study included 2458 children receiving respiratory ECMO, with an overall mortality rate of 39.8%.
- The Ped-RESCUERS model incorporated pre-ECMO pH, PaCO2, intubation duration, admission duration, ventilator type, mean airway pressure, milrinone use, and specific diagnoses.
- The developed model achieved an AUC of 0.690 in the development set and 0.634 in the validation set.
Conclusions:
- The Ped-RESCUERS score offers a new method for estimating pre-ECMO mortality risk in pediatric patients.
- Further external validation and refinement are recommended to improve the discrimination of this mortality prediction tool.
- The score's utility lies in its potential to guide clinical decision-making and resource allocation for pediatric ECMO.
Purpose:
To develop and validate the Pediatric Risk Estimation Score for Children Using Extracorporeal Respiratory Support (Ped-RESCUERS). Ped-RESCUERS is designed to estimate the in-hospital mortality risk for children prior to receiving respiratory extracorporeal membrane oxygenation (ECMO) support.
Methods:
This study used data from an international registry of patients aged 29 days to less than 18 years who received ECMO support from 2009 to 2014. We divided the registry into development and validation datasets by calendar date. Candidate variables were selected for model inclusion if the variable independently changed the mortality risk by at least 2 % in a Bayesian logistic regression model with in-hospital mortality as the outcome. We characterized the model's ability to discriminate mortality with the area under curve (AUC) of the receiver operating characteristic.
Results:
From 2009 to 2014, 2458 non-neonatal children received ECMO for respiratory support, with a mortality rate of 39.8 %. The development dataset contained 1611 children receiving ECMO support from 2009 to 2012. The model included the following variables: pre-ECMO pH, pre-ECMO arterial partial pressure of carbon dioxide, hours of intubation prior to ECMO support, hours of admission at ECMO center prior to ECMO support, ventilator type, mean airway pressure, pre-ECMO use of milrinone, and a diagnosis of pertussis, asthma, bronchiolitis, or malignancy. The validation dataset included 438 children receiving ECMO support from 2013 to 2014. The Ped-RESCUERS model from the development dataset had an AUC of 0.690, and the validation dataset had an AUC of 0.634.
Conclusions:
Ped-RESCUERS provides a novel measure of pre-ECMO mortality risk. Future studies should seek external validation and improved discrimination of this mortality prediction tool.
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