Comparative assessment of acceptability of the prognostic scales in predicting the risk of interhospital evacuation of newborns

Abstract

BACKGROUND: The safety of interhospital transfer of newborns remains one of the most important issues of emergency neonatology. Assessment of risks associated with transfer is the basic concern of pre-transport preparation.

AIM: This study aimed to assess and compare the predictive value of the KSCHONN, National Therapeutic Intervention Scoring System (NTISS), and TRIPS scales in predicting the risks associated with the interhospital transfer of newborns.

MATERIALS AND METHODS: The cohort study included data from 604 visits of the transport team. The KSHONN, NTISS, and TRIPS scales were used in the assessments, the therapeutic actions of the transport team during transfer were evaluated, and mortality during the first day after assessments was analyzed. The area under the receiver operating characteristic curve (AUC ROC) was calculated for the KSCHONN, NTISS, and TRIPS scales in relation to the therapeutic actions of the transport team and first-day mortality.

RESULTS: The predictive values of the KSHONN and TRIPS scales for additional infusion reflected AUC ROC values of 0.877 (0.436–1.317) and AUC ROC 0.889 (0.468–1.311), respectively. The AUC ROC value for predicting catecholamine dose adjustment or appointment and correction of ventilation for all three scales was less than 0.8. The predictive value of all three scales in the prediction of death on the day after the assessment of the transport team is high, and the TRIPS scale had the highest AUC ROC [0.988 (0.977–0.999)], which was significantly higher than that for the NTISS scale 0.875 (0.790–0.959) (p = 0.004). The KSHONN scale demonstrated a better predictive value for daily mortality [0.984 (0.861–1.003)] in comparison with NTISS (p = 0.001). The risk ratio of the daily mortality in the group of patients with an assessment of 9–4 points according to KSHONN in comparison with patients with an assessment of 6–8 points was 17.73 (0.88–355.8).

CONCLUSIONS: The evaluated scales predict patient death within a day after the assessment of the transport team with good accuracy, and the KSHONN and TRIPS scales predict the need for additional infusion during transfer. However, none of the scales predict other actions of the team associated with the deterioration of the patient’s condition during transfer with the required accuracy.

Keywords

newborn transfer / disease severity scoring systems / prognostic scales / adverse events

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Mukhametshin R.F., Davidova N.S.