SNAP-II Predicts Mortality among Infants with Congenital Diaphragmatic Hernia

OBJECTIVE: Outcomes analysis in congenital diaphragmatic hernia (CDH) requires a validated risk-adjustment tool. The purpose of this study was to use the Canadian Neonatal Network (CNN) database to validate the Score for Neonatal Acute Physiology, Version II (SNAP-II) for prediction of mortality amo...

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Veröffentlicht in:Journal of Perinatology 2005-05, Vol.25 (5), p.315-319
Hauptverfasser: Skarsgard, Erik D, MacNab, Ying C, Qiu, Zhenguo, Little, Ruth, Lee, Shoo K
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container_issue 5
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creator Skarsgard, Erik D
MacNab, Ying C
Qiu, Zhenguo
Little, Ruth
Lee, Shoo K
description OBJECTIVE: Outcomes analysis in congenital diaphragmatic hernia (CDH) requires a validated risk-adjustment tool. The purpose of this study was to use the Canadian Neonatal Network (CNN) database to validate the Score for Neonatal Acute Physiology, Version II (SNAP-II) for prediction of mortality among CDH infants admitted to a neonatal intensive care unit (NICU), and to compare this to the predictive equation recently developed by the Congenital Diaphragmatic Hernia Study Group (CDHSG). STUDY DESIGN: Infants with CDH in the CNN database were identified. Bivariate and multivariable logistic regression models were used to identify risk factors predictive of mortality. Model predictive performance and calibration were assessed using the area under the receiver operator characteristic curve and the technique of Hosmer-Lemeshow, respectively, and compared with the CDHSG predictive equation. RESULTS: There were 88 patients with CDH among 19,507 admissions to CNN hospitals. The mortality rate among CDH patients surviving to NICU admission was 17%, and 12.5% received extracorporeal membrane oxygenation therapy. Gestational age and admission SNAP-II score predicted mortality. Model predictive performance and calibration were optimized with these variables combined. The CDHSG equation was equally predictive of mortality, but was only marginally calibrated. CONCLUSIONS: SNAP-II is highly predictive of mortality among patients with CDH, and can be used to risk-adjust these patients.
doi_str_mv 10.1038/sj.jp.7211257
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The purpose of this study was to use the Canadian Neonatal Network (CNN) database to validate the Score for Neonatal Acute Physiology, Version II (SNAP-II) for prediction of mortality among CDH infants admitted to a neonatal intensive care unit (NICU), and to compare this to the predictive equation recently developed by the Congenital Diaphragmatic Hernia Study Group (CDHSG). STUDY DESIGN: Infants with CDH in the CNN database were identified. Bivariate and multivariable logistic regression models were used to identify risk factors predictive of mortality. Model predictive performance and calibration were assessed using the area under the receiver operator characteristic curve and the technique of Hosmer-Lemeshow, respectively, and compared with the CDHSG predictive equation. RESULTS: There were 88 patients with CDH among 19,507 admissions to CNN hospitals. The mortality rate among CDH patients surviving to NICU admission was 17%, and 12.5% received extracorporeal membrane oxygenation therapy. Gestational age and admission SNAP-II score predicted mortality. Model predictive performance and calibration were optimized with these variables combined. The CDHSG equation was equally predictive of mortality, but was only marginally calibrated. CONCLUSIONS: SNAP-II is highly predictive of mortality among patients with CDH, and can be used to risk-adjust these patients.</description><identifier>ISSN: 0743-8346</identifier><identifier>EISSN: 1476-5543</identifier><identifier>DOI: 10.1038/sj.jp.7211257</identifier><identifier>PMID: 15716986</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>Apgar score ; Birth weight ; Bivariate analysis ; Calibration ; Cause of Death ; Cohort Studies ; Critical Care - standards ; Critical Care - trends ; Diaphragm ; Extracorporeal membrane oxygenation ; Female ; Gestational age ; Health Status Indicators ; Hernia ; Hernia, Diaphragmatic - diagnosis ; Hernia, Diaphragmatic - mortality ; Hernias ; Hernias, Diaphragmatic, Congenital ; Humans ; Infant, Newborn ; Infants ; Intensive care ; Intensive Care Units, Neonatal ; Logistic Models ; Male ; Medicine ; Medicine &amp; Public Health ; Mortality ; Multiple births ; Neonates ; Online databases ; Ontario ; original-article ; Oxygenation ; Patient outcomes ; Patients ; Pediatric Surgery ; Pediatrics ; Performance prediction ; Physiology ; Population ; Probability ; Regression analysis ; Regression models ; Risk analysis ; Risk Assessment ; Risk factors ; ROC Curve ; Severity of Illness Index ; Surgery ; Survival Rate ; Urban Population ; Variables ; Womens health</subject><ispartof>Journal of Perinatology, 2005-05, Vol.25 (5), p.315-319</ispartof><rights>Springer Nature America, Inc. 2005</rights><rights>COPYRIGHT 2005 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group May 2005</rights><rights>Nature Publishing Group 2005.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4207-4bb4a3140574411b9d00613bbe358d7d799c7c36e1fcbab05167a818fed4f7593</citedby><cites>FETCH-LOGICAL-c4207-4bb4a3140574411b9d00613bbe358d7d799c7c36e1fcbab05167a818fed4f7593</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/sj.jp.7211257$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/sj.jp.7211257$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15716986$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Skarsgard, Erik D</creatorcontrib><creatorcontrib>MacNab, Ying C</creatorcontrib><creatorcontrib>Qiu, Zhenguo</creatorcontrib><creatorcontrib>Little, Ruth</creatorcontrib><creatorcontrib>Lee, Shoo K</creatorcontrib><creatorcontrib>Canadian Neonatal Network</creatorcontrib><creatorcontrib>The Canadian Neonatal Network</creatorcontrib><title>SNAP-II Predicts Mortality among Infants with Congenital Diaphragmatic Hernia</title><title>Journal of Perinatology</title><addtitle>J Perinatol</addtitle><addtitle>J Perinatol</addtitle><description>OBJECTIVE: Outcomes analysis in congenital diaphragmatic hernia (CDH) requires a validated risk-adjustment tool. The purpose of this study was to use the Canadian Neonatal Network (CNN) database to validate the Score for Neonatal Acute Physiology, Version II (SNAP-II) for prediction of mortality among CDH infants admitted to a neonatal intensive care unit (NICU), and to compare this to the predictive equation recently developed by the Congenital Diaphragmatic Hernia Study Group (CDHSG). STUDY DESIGN: Infants with CDH in the CNN database were identified. Bivariate and multivariable logistic regression models were used to identify risk factors predictive of mortality. Model predictive performance and calibration were assessed using the area under the receiver operator characteristic curve and the technique of Hosmer-Lemeshow, respectively, and compared with the CDHSG predictive equation. RESULTS: There were 88 patients with CDH among 19,507 admissions to CNN hospitals. The mortality rate among CDH patients surviving to NICU admission was 17%, and 12.5% received extracorporeal membrane oxygenation therapy. Gestational age and admission SNAP-II score predicted mortality. Model predictive performance and calibration were optimized with these variables combined. The CDHSG equation was equally predictive of mortality, but was only marginally calibrated. 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The mortality rate among CDH patients surviving to NICU admission was 17%, and 12.5% received extracorporeal membrane oxygenation therapy. Gestational age and admission SNAP-II score predicted mortality. Model predictive performance and calibration were optimized with these variables combined. The CDHSG equation was equally predictive of mortality, but was only marginally calibrated. CONCLUSIONS: SNAP-II is highly predictive of mortality among patients with CDH, and can be used to risk-adjust these patients.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>15716986</pmid><doi>10.1038/sj.jp.7211257</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record>
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subjects Apgar score
Birth weight
Bivariate analysis
Calibration
Cause of Death
Cohort Studies
Critical Care - standards
Critical Care - trends
Diaphragm
Extracorporeal membrane oxygenation
Female
Gestational age
Health Status Indicators
Hernia
Hernia, Diaphragmatic - diagnosis
Hernia, Diaphragmatic - mortality
Hernias
Hernias, Diaphragmatic, Congenital
Humans
Infant, Newborn
Infants
Intensive care
Intensive Care Units, Neonatal
Logistic Models
Male
Medicine
Medicine & Public Health
Mortality
Multiple births
Neonates
Online databases
Ontario
original-article
Oxygenation
Patient outcomes
Patients
Pediatric Surgery
Pediatrics
Performance prediction
Physiology
Population
Probability
Regression analysis
Regression models
Risk analysis
Risk Assessment
Risk factors
ROC Curve
Severity of Illness Index
Surgery
Survival Rate
Urban Population
Variables
Womens health
title SNAP-II Predicts Mortality among Infants with Congenital Diaphragmatic Hernia
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