Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Anesthesiology, Weill Cornell Medicine, New York, New York.
Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Anesthesiology. 2022 Nov 1;137(5):555-567. doi: 10.1097/ALN.0000000000004369.
There are multiple preoperative risk scores for pediatric mortality. The aim of this study was to systematically describe and compare the existing studies of patient-specific multispecialty risk prediction scores for perioperative mortality in pediatric populations, with the goal of guiding clinicians on which may be most appropriate for use in the preoperative setting.
This study is a systematic literature review of published journal articles that presented the development, extension/updating, and/or validation of a risk core that predicted all-cause mortality (up to 30 days postoperatively) in pediatric patients undergoing a procedure in which anesthesia was used. Scores needed to be applicable to surgeries in more than one noncardiac surgical specialty and had to be able to be calculated by the anesthesiologist at the time of the preanesthetic assessment. Two investigators independently screened studies for inclusion and assessed study quality in the domains of clinical applicability, feasibility/ease of use in the clinical setting, and risk of bias.
A total of 1,681 titles were retrieved. Of these, 10 studies met inclusion criteria: 9 reported the development and validation of scores, and 1 was an external validation of an existing score. Seven studies used varying years of multicenter data from the National Surgical Quality Improvement Program-Pediatric Participant Use File for development and/or validation. The unadjusted rate of mortality in the studies ranged from 0.3 to 3.6%. The preoperative predictors of mortality used in score development included patient demographics, preoperative therapies, and chronic conditions, among others. All models showed good discrimination upon validation (area under the receiver operating characteristics curve greater than 0.8). Most risk scores had high or unclear risks of bias.
There are numerous scores available for the prediction of mortality in pediatric populations, all of which exhibited good performance. However, many have high or unclear risks of bias, and most have not undergone external validation.
有多种针对儿科死亡率的术前风险评分。本研究旨在系统地描述和比较现有的针对儿科患者围手术期死亡率的多专科患者特异性风险预测评分研究，旨在为临床医生指导哪种评分最适合用于术前。
本研究是对已发表的期刊文章的系统文献回顾，这些文章介绍了风险核心的开发、扩展/更新和/或验证，该风险核心预测了接受麻醉的手术中所有原因死亡率（术后 30 天内）的儿科患者。评分必须适用于多个非心脏外科专科的手术，并且必须能够由麻醉医师在术前评估时计算。两名调查员独立筛选研究纳入情况，并评估临床适用性、临床环境中的可行性/易用性以及偏倚风险等领域的研究质量。
共检索到 1681 篇标题。其中，10 项研究符合纳入标准：9 项报告了评分的开发和验证，1 项是对现有评分的外部验证。7 项研究使用了来自国家手术质量改进计划-儿科参与者使用文件的不同年份的多中心数据进行开发和/或验证。研究中未调整的死亡率范围为 0.3%至 3.6%。评分开发中用于预测死亡率的术前预测因素包括患者人口统计学、术前治疗和慢性疾病等。所有模型在验证时均表现出良好的区分度（接受者操作特征曲线下面积大于 0.8）。大多数风险评分存在高或不明确的偏倚风险。
有许多评分可用于预测儿科人群的死亡率，所有评分的性能都很好。然而，许多评分存在高或不明确的偏倚风险，并且大多数评分尚未经过外部验证。
