PRISM-III and SNAPPE-II to Predict Outcome in Neonates undergoing Surgery under General AnaesthesiaA Prospective Cohort Study

Abstract

Introduction: Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPE-II) and Paediatric Risk of Mortality-III (PRISM-III) are scores which have been used in the Paediatric Intensive Care Unit (PICU) setting for quite some time now. However, these have never been utilised in a preoperative setting to predict outcome. Aim: To study the risk scores PRISM-III and SNAPPE-II to predict outcome in neonates undergoing surgery under general anaesthesia. Materials and Methods: This was a prospective observational cohort study conducted in Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India on 100 neonates. The PRISM-III and SNAPPE-II scores were calculated preoperatively to predict the postoperative outcome. Statistical Package for Social Sciences (SPSS) version 15.0 was used for analysis. Discriminatory capacity of scores was assessed using Receiver Operating Characteristic (ROC) curves. Specificity and sensitivity were calculated to identify the cut-off value of the scoring system that would predict outcome. The calibration of both the scoring systems was established by using HosmerLemeshow goodness of fit test. Results: The mean age of population was 8.23±7.93 days, with 69% males and 31% females. The mortality rate was 12%. The maximum sensitivity (91.67%) and specificity (93.18%) for PRISMIII score was found at score 23, whereas best sensitivity (100%) and specificity (81.82%) for SNAPPE-II was at 26.5. The area under ROC for PRISM-III and SNAPPE-II was 0.946 and 0.944 respectively showing excellent discriminatory power. The HosmerLemeshow test showed a good calibration for the study model. Conclusion: Both the scoring systems PRISM-III and SNAPPEII are excellent predictors of postoperative outcomes. PRISMIII is marginally better than SNAPPE-II for diagnostic accuracy. Both scores are well calibrated for Indian population.