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Modified paediatric preoperative risk prediction score to predict postoperative ICU admission in children: a
Chunwei Lian1, Pei Wang1,2, Qingxia Fu1
1Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital & Yuying Children's hospital of Wenzhou Medical University, Wenzhou, China.
Insights
A new modified paediatric preoperative risk prediction score (PRPS) integrating surgical risk improves prediction accuracy for intensive care unit (ICU) admission in children undergoing surgery.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Accurate prediction of postoperative intensive care unit (ICU) admission is crucial for pediatric surgical patients.
- Existing risk prediction scores may not fully capture intrinsic surgical risks.
- A more comprehensive scoring system is needed to improve patient management.
Purpose of the Study:
- To develop and validate a modified paediatric preoperative risk prediction score (PRPS) by integrating intrinsic surgical risk.
- To enhance the prediction accuracy of postoperative ICU admission in pediatric patients.
- To compare the performance of the modified PRPS against the original PRPS and the American Society of Anaesthesiology physical status (ASA-PS).
Main Methods:
- Retrospective study including 9261 pediatric patients (≤14 years) undergoing surgery under general anesthesia.
- Data collected included age, ASA-PS, oxygen saturation, prematurity, non-fasted status, surgical severity, and ICU transfer.
- The modified PRPS was developed using logistic regression and validated against the original PRPS and ASA-PS using ROC curve and Kappa analysis.
Main Results:
- The modified PRPS demonstrated superior predictive performance compared to the original PRPS and ASA-PS.
- Area under the ROC curve for modified PRPS was 0.963, compared to 0.941 for paediatric PRPS and 0.870 for ASA-PS.
- Kappa values indicated better agreement for the modified PRPS (0.620) versus paediatric PRPS (0.286) and ASA-PS (0.267).
Conclusions:
- The modified PRPS, incorporating intrinsic surgical risk, offers improved prediction accuracy for postoperative ICU admission in pediatric surgical patients.
- This enhanced scoring system can aid in better preoperative risk assessment and resource allocation.
- The findings support the clinical utility of the modified PRPS in pediatric anesthesia and surgery.
Objective:
To integrate intrinsic surgical risk into the paediatric preoperative risk prediction score (PRPS) model to construct a more comprehensive risk scoring system (modified PRPS) and improve the prediction accuracy of postoperative intensive care unit (ICU) admission in paediatric patients.
Design:
This was a retrospective study conducted between 1 January and 30 December 2016. Data on age, American Society of Anaesthesiology physical status (ASA-PS), oxygen saturation, prematurity, non-fasted status, severity of surgery and immediate transfer to the ICU after surgery were collected. The modified PRPS was developed by logistic regression in the derivation cohort; it was tested and compared with the paediatric PRPS and ASA-PS by the Hosmer-Lemeshow test, the receiver operating characteristic (ROC) curve and Kappa analysis in the validation cohort.
Setting:
Hospital-based study in China.
Participants:
Paediatric patients (≤14 years) who underwent surgery under general anaesthesia were included, and those who needed reoperation due to surgical complications or stayed in the ICU preoperatively were excluded.
Main Outcome Measure:
ICU admission rate, defined as any patients' direct disposition from the operating room to the ICU immediately after the surgery.
Results:
A total of 9261 paediatric patients were included in this study, with 418 patients admitted to the ICU. In the validation cohort, the modified PRPS model fit the test data well (deciles of risk goodness-of-fit χ2=6.84, p=0.077). The area under the ROC curve of the modified PRPS, paediatric PRPS and ASA-PS were 0.963, 0.941 and 0.870, respectively (p<0.05), and the Kappa values were 0.620, 0.286 and 0.267. Analyses in the cohort indicated that the modified PRPS was superior to the paediatric PRPS and ASA-PS.
Conclusions:
The modified PRPS integrating intrinsic surgical risk shows better prediction accuracy than the previous PRPS.
