Development and Validation of the Neonatal Risk Estimate Score for Children Using Extracorporeal Respiratory Support.
Development and Validation of the Neonatal Risk Estimate Score for Children Using Extracorporeal Respiratory Support.
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DOI：
10.1016/j.jpeds.2016.02.057
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发表时间：
2016-06
期刊：
影响因子：
--
通讯作者：
Davis MM
中科院分区：
文献类型：
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作者：
Barbaro RP;Bartlett RH;Chapman RL;Paden ML;Roberts LA;Gebremariam A;Annich GM;Davis MM
To develop and validate the Neonatal Risk Estimate Score for Children Using Extracorporeal Respiratory Support (Neo-RESCUERS), which estimates the risk of in-hospital death for neonates prior to receiving respiratory extracorporeal membrane oxygenation (ECMO) support. We used an international ECMO registry (2008–2013); neonates receiving ECMO for respiratory support were included. We divided the registry into a derivation sample and internal validation sample, by calendar date. We chose candidate variables a priori based on published evidence of association with mortality; variables independently associated with mortality in logistic regression were included in this parsimonious model of risk adjustment. We evaluated model discrimination with the area under the receiver operating characteristic curve (AUC) and we evaluated calibration with the Hosmer-Lemeshow goodness-of-fit test. During 2008–2013, 4,592 neonates received ECMO respiratory support with mortality of 31%. The development dataset contained 3,139 patients treated in 2008–2011. The Neo-RESCUERS measure had an AUC of 0.78 (95% confidence interval: 0.76–0.79). The validation cohort had an AUC=0.77 (0.75–0.80). Patients in the lowest risk decile had an observed mortality of 7.0% and a predicted mortality of 4.4%, and those in the highest risk decile had an observed mortality of 65.6% and a predicted mortality of 67.5%. Neo-RESCUERS offers severity-of-illness adjustment for neonatal respiratory failure patients receiving ECMO. This score may be used to adjust patient survival to assess hospital-level performance in ECMO-based care.
