Pediatric Surgery International

, Volume 28, Issue 3, pp 271–276

Could clinical scores guide the surgical treatment of necrotizing enterocolitis?

  • Vicente Ibáñez
  • Miguel Couselo
  • Verónica Marijuán
  • Juan José Vila
  • Carlos García-Sala
Original Article

DOI: 10.1007/s00383-011-3016-z

Cite this article as:
Ibáñez, V., Couselo, M., Marijuán, V. et al. Pediatr Surg Int (2012) 28: 271. doi:10.1007/s00383-011-3016-z

Abstract

Purpose

Test the diagnostic reliability of the score for neonatal acute physiology-perinatal extension-II (SNAPPE-II) and the metabolic derangement acuity score (MDAS) as predictors of surgery in patients with necrotizing enterocolitis (NEC).

Methods

The SNAPPE-II and the MDAS were applied to 99 patients with NEC. Both the scores were calculated at the moment of diagnosis (T0) and when surgical assessment was required (T1). The main outcome was the need of surgical revision. Comparison between models was made through their receiver operator characteristics (ROC) curves.

Results

Thirty-five patients required surgical treatment (group A) and 64 responded to medical therapy (group B). Median SNAPPE-II was 22 versus 5 for group A (U test 621, p = 0.002) at T0; and 22 versus 10 for group A (U test 487, p = 0.01) at T1. Measuring the value of the SNAPPE-II as a predictor of surgery, the ROC curve was 0.69 (CI 95%, 0.57–0.80) at T0 and 0.67 (CI 95%, 0.55–0.80) at T1. Median MDAS were 2 for both groups A and B at T0 (U test 890.5, p = 0.113) and 2 versus 1.5 for group A at T1 (U test 570, p = 0.043). The ROC curve for MDAS was 0.59 (CI 95%, 0.47–0.71) at T0 and 0.64 (CI 95%, 0.52–0.77) at T1.

Conclusions

The diagnostic performance of the SNAPPE-II offers mild results in the moment of the diagnosis of NEC, and at T1. The MDAS is non significant at T0 and obtains moderate results at T1. These results do not encourage using the SNAPPE-II and the MDAS as definite tools to decide for surgical treatment of the patients affected by NEC.

Keywords

Necrotizing enterocolitis Score ROC curve Surgical treatment 

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Vicente Ibáñez
    • 1
  • Miguel Couselo
    • 1
  • Verónica Marijuán
    • 1
  • Juan José Vila
    • 1
  • Carlos García-Sala
    • 1
  1. 1.Hospital Infantil La FeValenciaSpain

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