Tomar Apurva, Panda Prateek K, Elwadhi Aman, Tiwari Lokesh K, Sharawat Indar K
Department of Pediatrics, Pediatric Neurology Division, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Pediatrics, Pediatric Intensive Care and Pulmonology Division, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Indian J Crit Care Med. 2025 Jul;29(7):578-585. doi: 10.5005/jp-journals-10071-25013. Epub 2025 Jul 7.
Currently, no validated scoring system exists to predict neurological outcomes in mechanically ventilated children. We aimed to develop and validate such a score in this population.
We developed the NOPS-VC score, comprising eight items. Each parameter is rated on a Likert scale, where a minimum score of 1 indicates no significant risk, and a maximum score of 3 represents the highest risk for poor neurological outcomes. The face and content validity of the score were assessed using the content validity index (CVI) and content validity ratio. Neurological outcomes were determined at discharge and at 6 months of follow-up. Construct validity was assessed by correlating the NOPS-VC score with the Pediatric Cerebral Performance Category score, functional status scale (FSS), intelligence quotient (IQ), Vineland Adaptive Behavior Scale, gross motor function measure (GMFM), child behavior checklist, and pediatric quality of life inventory.
Among 170 participants, 87 had good functional outcomes. The scale-level content validity index (S-CVI/UA) was 0.95, and S-CVI/Ave was 0.9, indicating excellent content validity. The one-factor model demonstrated a good fit, with all item loadings exceeding 0.7 [Tucker-Lewis index (TLI) = 0.95, comparative fit index (CFI) = 0.96, root mean squared error of approximation (RMSEA) = 0.067 (0.059-0.074)]. The area under the receiver operating characteristic (ROC) curve for the maximum and baseline NOPS-VC scores was 0.92 and 0.91, respectively. The optimal cutoff value for both scores was 18, with sensitivity/specificity of 82/97% for the maximum score and 80/97% for the baseline score. Construct validity showed strong correlations ( ≥ 0.70) with all parameters.
The NOPS-VC score, when applied at the initiation of mechanical ventilation in critically ill children, demonstrates strong validity in predicting neurological outcomes at 6 months, with an optimal cutoff value of 18.
Tomar A, Panda PK, Elwadhi A, Tiwari LK, Sharawat IK. Development and Validation of a Neurological Outcome Prediction Score for Children Requiring Mechanical Ventilation: The NOPS-VC Score. Indian J Crit Care Med 2025;29(7):578-585.
目前，尚无经过验证的评分系统可用于预测机械通气儿童的神经学预后。我们旨在开发并验证适用于该人群的此类评分。
我们开发了包含八个项目的NOPS-VC评分。每个参数采用李克特量表进行评分，最低分为1表示无显著风险，最高分为3表示神经学预后不良的最高风险。使用内容效度指数（CVI）和内容效度比评估该评分的表面效度和内容效度。在出院时及随访6个月时确定神经学预后。通过将NOPS-VC评分与儿科脑功能表现类别评分、功能状态量表（FSS）、智商（IQ）、文兰适应性行为量表、粗大运动功能测量（GMFM）、儿童行为清单和儿科生活质量量表进行关联来评估结构效度。
在170名参与者中，87名具有良好的功能预后。量表水平的内容效度指数（S-CVI/UA）为0.95，S-CVI/Ave为0.9，表明具有出色的内容效度。单因素模型显示拟合良好，所有项目载荷均超过0.7 [塔克-刘易斯指数（TLI）= 0.95，比较拟合指数（CFI）= 0.96，近似误差均方根（RMSEA）= 0.067（0.059 - 0.074）]。最大和基线NOPS-VC评分的受试者工作特征（ROC）曲线下面积分别为0.92和0.91。两个评分的最佳截断值均为18，最大评分的灵敏度/特异度为82/97%，基线评分的灵敏度/特异度为80/97%。结构效度显示与所有参数均具有强相关性（≥ 0.70）。
在危重症儿童机械通气开始时应用NOPS-VC评分，在预测6个月时的神经学预后方面具有很强的效度，最佳截断值为18。
Tomar A, Panda PK, Elwadhi A, Tiwari LK, Sharawat IK. 用于需要机械通气儿童的神经学预后预测评分的开发与验证：NOPS-VC评分。《印度重症医学杂志》2025；29(7):578 - 585。
