Revalidation of the score for neonatal acute physiology in the Vermont Oxford Network
Revalidation of the score for neonatal acute physiology in the Vermont Oxford Network
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DOI：
10.1542/peds.2005-2957
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发表时间：
2007-01-01
期刊：
影响因子：
8
通讯作者：
Escobar, Gabriel J.
中科院分区：
文献类型：
--
作者：
Zupancic, John A. F.;Richardson, Douglas K.;Escobar, Gabriel J.
目标.我们的具体目标是：（1）记录修订后的新生儿急性生理学评分和修订后的新生儿急性生理学评分围产期扩展在预测佛蒙特牛津网络中死亡方面的表现，与已发表的标准值相比;（2）确定是否可以通过重新校准单个评分项目的权重来提高这一表现;（3）确定在预测模型中包括先天性异常的影响;（4）将性能与佛蒙特州牛津网络风险调整的性能进行比较，单独和组合。2002年，58个佛蒙特牛津网络中心前瞻性收集了新生儿入院后12小时内的新生儿急性生理学修订评分数据。收集了10469名婴儿的数据，并对9897名符合纳入标准的婴儿进行了分析。新生儿急性生理学的中位修订评分为5分，平均出生体重为1951 g。新生儿急性生理学和新生儿急性生理学围产期扩展的修订分数的重新校准导致他们的辨别能力的变化最小。与修订后的新生儿急性生理学围产期扩展评分相比，Vermont Oxford网络风险调整的表现相似。目前的评分表现与之前观察到的相似，这表明自第一个队列组装以来，新生儿急性生理学修订评分和新生儿急性生理学围产期扩展修订评分在7年内没有重新校准，尽管在此期间新生儿护理取得了进展。在修订的新生儿急性生理学围产期扩展评分中增加先天性异常显著改善了区分，特别是对于出生体重> 1500 g的婴儿。与修订后的新生儿急性生理学围产期扩展评分相比，佛蒙特牛津网络风险调整表现相似。
OBJECTIVES. Our specific objectives were (1) to document the performance of the revised Score for Neonatal Acute Physiology and the revised Score for Neonatal Acute Physiology Perinatal Extension in predicting death in the Vermont Oxford Network, compared with published normative values; (2) to determine whether this performance could be improved through recalibration of the weights for individual score items; (3) to determine the impact of including congenital anomalies in the predictive model; and (4) to compare performance against that of the Vermont Oxford Network risk adjustment, separately and in combination.METHODS. Fifty-eight Vermont Oxford Network centers collected data prospectively for the revised Score for Neonatal Acute Physiology in the first 12 hours after admission of infants in 2002.RESULTS. Data were collected for 10 469 infants, and analyses were undertaken for 9897 who met inclusion criteria. The median revised Score for Neonatal Acute Physiology was 5, and the mean birth weight was 1951 g. Recalibration of the revised Score for Neonatal Acute Physiology and revised Score for Neonatal Acute Physiology Perinatal Extension resulted in minimal changes in their discriminatory abilities. The Vermont Oxford Network risk adjustment performed similarly, compared with the revised Score for Neonatal Acute Physiology Perinatal Extension.CONCLUSIONS. Current score performance was similar to that observed previously, which suggests that the revised Score for Neonatal Acute Physiology and revised Score for Neonatal Acute Physiology Perinatal Extension have not decalibrated over the 7 years since the first cohort was assembled, despite advances in neonatal care during that period. Addition of congenital anomalies to the revised Score for Neonatal Acute Physiology Perinatal Extension improved discrimination significantly, particularly for infants with birth weights of > 1500 g. The Vermont Oxford Network risk adjustment performed similarly, compared with the revised Score for Neonatal Acute Physiology Perinatal Extension.