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Predicting Perioperative Respiratory Adverse Events in Children Undergoing Elective Surgeries Under General
Essam Mohamed H Hegazy1, Houda Almusalhi2, Suhrud Panchawagh3
1Anesthesia and Critical Care, Ibra Hospital, Ibra, OMN.
Insights
The COLDS score helps identify children at risk for breathing problems after surgery. While specific, it should complement clinical judgment for accurate risk assessment in pediatric patients with upper respiratory infections.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Pediatric patients with recent upper respiratory tract infections (URTIs) present significant anesthetic challenges.
- Perioperative respiratory adverse events (PRAEs) are a concern in this population.
Purpose of the Study:
- To evaluate the COLDS score as a pre-anesthetic tool for predicting PRAEs in pediatric surgical patients with URTI.
- To assess the discriminatory ability of the COLDS score.
Main Methods:
- Prospective data collection over six months from children (age >1 year) undergoing elective ENT surgeries under general anesthesia (GA).
- Exclusion criteria included children <1 year, non-ENT surgeries, and emergency procedures.
- Analysis of 270 patients to determine the COLDS score's predictive value for PRAEs.
Main Results:
- 25 (9.3%) patients experienced postoperative events.
- The COLDS score demonstrated strong discriminatory ability (AUC 0.92) and high specificity (97.96%).
- Sensitivity was moderate at 40.0%, indicating a significant number of events were not detected by the score alone.
Conclusions:
- The COLDS score is effective in distinguishing patients likely to experience PRAEs.
- Due to moderate sensitivity, the COLDS score should be used alongside comprehensive clinical evaluation and surgical type assessment.
- This approach enhances risk stratification for pediatric patients undergoing surgery with URTI.
Abstract:
Background and aims Pediatric patients undergoing surgeries under general anesthesia (GA) who have a recent upper respiratory tract infection (URTI) pose a unique challenge for the anesthesiologists. We aimed to utilize the COLDS score as a pre-anesthetic risk assessment tool to predict the likelihood of perioperative respiratory adverse events (PRAEs) in children with URTI. Methods and materials After ethical approval, we prospectively collected data over six months from children undergoing various ear, nose, and throat (ENT) surgeries under GA. Children above one year undergoing elective ENT surgeries were included. Children less than one year, non-ENT surgical pediatric patients, and those undergoing emergency surgeries were excluded. Results A total of 270 patients were included in the analysis, among whom 25 (9.3%) experienced postoperative events. The COLDS score was able to effectively distinguish between patients who did and did not experience postoperative complications. The receiver operating characteristic (ROC) curve (AUC) of 0.92 (95% CI: 0.86-0.99) suggests a strong discriminatory ability of the score. The specificity of the model was high at 97.96% (95% CI: 95.9-99.6), suggesting a strong ability to correctly identify patients without events. The sensitivity was lower at 40.0% (95% CI: 20.7-60.0), i.e., only 40% of patients who experienced complications were detected by the score. Conclusions COLDS score can help in distinguishing patients who will and will not have PRAEs. But as the sensitivity is moderate, we recommend using the COLDS score along with a detailed clinical assessment based on the type of surgery planned.
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