A simple clinical score to predict outcome in hospitalized extramural neonates

Jasmeet Sidhu, Harmesh Singh Bains

Abstract


Background: Illness severity scores can guide to optimize the limited health care resources in developing nations. The aim of this study was to develop a clinical score for severity of illness to help prioritize care and predict outcome of neonates admitted in emergency department.  

Methods: Prospective hospital based observational study. Out of total 419 neonates who attended Emergency Department, 341 were included in the study. The neonates were screened for 20 clinical parameters at admission and a score of 0, 1 & 2 was assigned for each parameter depending upon severity. The outcome (death/discharge) was correlated with the study variables and total score. The predictive ability of score was calculated using Receiver Operating Characteristic curve (ROC) analysis. Every 10th case was also evaluated with Score for Neonatal Acute Physiology (SNAP) score and served as controls.

Results: Of the 20 variables, 13 variables were found to be significantly associated with mortality. Mortality increased with the increase in the total score. The predictive ability of score calculated using ROC curve was 85.2. Maximum discrimination was observed at score of 17. The 36 control cases which were evaluated with SNAP score also had predictive value of 92.2. There was no statistically significant difference in the predictive values of Clinical Score and SNAP (P value >0.05).

Conclusions: In emergency department, any sick neonate with clinical score 17 or more should be closely monitored and evaluated. These patients require admission as they have a potential risk of death. 


Keywords


Clinical score, Neonate, Outcome

Full Text:

PDF

References


Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S. 3.6 million neonatal deaths--what is progressing and what is not? Semin Perinatol. 2010 Dec;34(6):371-86.

Richardson DK, Gray JE, McCormick MC, Workman K, Goldmann DA. Score for Neonatal Acute Physiology: a physiologic severity index for neonatal intensive care. Pediatrics. 1993 Mar;91(3):617-23.

Richardson DK, Phibbs CS, Gray JE, McCormick MC, Workman-Daniels K, Goldmann DA. Birth weight and illness severity: independent predictors of neonatal mortality. Pediatrics. 1993 May;91(5):969-75.

The International Neonatal Network. The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. Lancet. 1993 Jul 24;342(8865):193-8.

Dorling JS, Field DJ, Manktelow B. Neonatal disease severity scoring systems. Arch Dis Child Fetal Neonatal Ed. 2005 Jan;90(1):F11-16.

Lemeshow S, Hosmer DW. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982 Jan;115(1):92-106.

Vasudevan A, Malhotra A, Lodha R, Kabra SK. Profile of neonates admitted in pediatric ICU and validation of score for neonatal acute physiology (SNAP). Indian Pediatr. 2006 Apr;43(4):344-8.