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Updated: Jan 11, 2026
Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
A retrospective case-control study comparing 2 opioid risk mitigation tools in noncritical, nonsurgical hospitalized
Kimm M Grafenreed-Freeman1, Paul Hughes2, Reem M Ghandour3
1Wellstar Cobb Hospital, Austell, GA, USA.
Purpose:
Effective pharmacist-led opioid stewardship relies on quality opioid risk mitigation tools to identify patients at greatest risk for respiratory compromise. This investigation compared the Michigan Opioid Safety Score (MOSS) to the PRediction of Opioid-induced Respiratory Depression In patients monitored by capnoGraphY (PRODIGY) tool for properly identifying nonsurgical, noncritical hospitalized patients who experienced opioid-induced respiratory depression (OIRD).
Methods:
A retrospective case-control study was undertaken to compare the capacity of the MOSS and PRODIGY tools to predict OIRD in nonsurgical, noncritical, adult patients exposed to opioids during their hospitalization. Patient exclusion criteria were as follows: admission to the emergency department, maternity ward, or a medical, cardiac, or neurology intensive care unit; no opioid administration; length of stay of <24 hours; and/or an observation status. MOSS and PRODIGY scores were manually calculated. The sensitivity, specificity, receiver operating characteristic (ROC) curve and area under the curve (AUC) of each tool were determined.
Results:
Three-hundred eighty-eight (388) patients were needed to establish statistical power; 778 patients were selected for the study. Of those, 216 met the inclusion criteria. PRODIGY had an 86.62% sensitivity and 20.27% specificity, whereas MOSS had a 2.82% sensitivity and a 100% specificity in predicting OIRD events. There was a statistically significant difference in sensitivity (83.8%; 95% CI, 77.4%-90.2%; P < 0.0001) supporting PRODIGY as a more sensitive tool for detecting OIRD. There was also a statistically significant difference in specificity between the tests (-79.7%; 95% CI, -88.9% to -70.6%; P < 0.0001), indicating MOSS is a more specific tool in detecting OIRD. The calculated AUC was 0.59 and 0.48 for PRODIGY and MOSS, respectively.
Conclusion:
The results imply PRODIGY is more sensitive than MOSS in identifying noncritical, nonsurgical hospitalized patients at risk for OIRD.
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