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Title: Predictive score for clinical complications during intra-hospital transports of infants treated in a neonatal unit
Authors: Vieira, Anna Luiza Pires [UNIFESP]
Dos Santos, Amelia Miyashiro [UNIFESP]
Okuyama, Mariana Kobayashi [UNIFESP]
Miyoshi, Milton Harumi [UNIFESP]
Almeida, Maria Fernanda Branco de [UNIFESP]
Guinsburg, Ruth [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Keywords: Risk index
transportation of patients
infant newborn
neonatal intensive care units
risk factors
Issue Date: 1-Jan-2011
Publisher: Faculdade de Medicina / USP
Citation: Clinics. Faculdade de Medicina / USP, v. 66, n. 4, p. 573-577, 2011.
Abstract: OBJECTIVE: To develop and validate a predictive score for clinical complications during intra-hospital transport of infants treated in neonatal units. METHODS: This was a cross-sectional study nested in a prospective cohort of infants transported within a public university hospital from January 2001 to December 2008. Transports during even (n=301) and odd (n = 394) years were compared to develop and validate a predictive score. The points attributed to each score variable were derived from multiple logistic regression analysis. The predictive performance and the score calibration were analyzed by a receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test, respectively. RESULTS: Infants with a mean gestational age of 35 + 4 weeks and a birth weight of 2457 + 841 g were studied. In the derivation cohort, clinical complications occurred in 74 (24.6%) transports. Logistic regression analysis identified five variables associated with these complications and assigned corresponding point values: gestation at birth [<28 weeks (6 pts); 28-34 weeks (3 pts); >34 weeks (2 pts)]; pre-transport temperature [<36.3°Cor >37°C(3pts); 36.3-37.0°C (2 pts)]; underlying pathological condition [CNS malformation (4 pts); other (2 pts)]; transport destination [surgery (5 pts); magnetic resonance or computed tomography imaging (3 pts); other (2 pts)]; and pre-transport respiratory support [mechanical ventilation (8 pts); supplemental oxygen (7 pts); no oxygen (2 pts)]. For the derivation and validation cohorts, the areas under the ROC curve were 0.770 and 0.712, respectively. Expected and observed frequencies of complications were similar between the two cohorts. CONCLUSION: The predictive score developed and validated in this study presented adequate discriminative power and calibration. This score can help identify infants at risk of clinical complications during intra-hospital transports.
ISSN: 1807-5932
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