Development and validation of the pediatric risk estimate score for children using extracorporeal respiratory support (Ped-RESCUERS)
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To develop and validate the Pediatric Risk Estimation Score for Children Using Extracorporeal Respiratory Support (Ped-RESCUERS). Ped-RESCUERS is designed to estimate the in-hospital mortality risk for children prior to receiving respiratory extracorporeal membrane oxygenation (ECMO) support.
This study used data from an international registry of patients aged 29 days to less than 18 years who received ECMO support from 2009 to 2014. We divided the registry into development and validation datasets by calendar date. Candidate variables were selected for model inclusion if the variable independently changed the mortality risk by at least 2 % in a Bayesian logistic regression model with in-hospital mortality as the outcome. We characterized the model’s ability to discriminate mortality with the area under curve (AUC) of the receiver operating characteristic.
From 2009 to 2014, 2458 non-neonatal children received ECMO for respiratory support, with a mortality rate of 39.8 %. The development dataset contained 1611 children receiving ECMO support from 2009 to 2012. The model included the following variables: pre-ECMO pH, pre-ECMO arterial partial pressure of carbon dioxide, hours of intubation prior to ECMO support, hours of admission at ECMO center prior to ECMO support, ventilator type, mean airway pressure, pre-ECMO use of milrinone, and a diagnosis of pertussis, asthma, bronchiolitis, or malignancy. The validation dataset included 438 children receiving ECMO support from 2013 to 2014. The Ped-RESCUERS model from the development dataset had an AUC of 0.690, and the validation dataset had an AUC of 0.634.
Ped-RESCUERS provides a novel measure of pre-ECMO mortality risk. Future studies should seek external validation and improved discrimination of this mortality prediction tool.
KeywordsExtracorporeal membrane oxygenation Risk assessment Risk adjustment Severity of illness index Mortality Pediatric
The authors would like to thank the Extracorporeal Life Support Organization for the opportunity to conduct this research. They also thank Folafoluwa O. Odetola, MD, MPH for his valuable assistance in editing and revising this manuscript.
Compliance with ethical standards
Conflicts of interest
Drs. Bartlett, Paden, and Annich acknowledge that they are on the Extracorporeal Life Support Organization steering committee. The other authors have no conflicts of interest relevant to this article to disclose.
Source of funding
Dr. Barbaro received a research award from the Extracorporeal Life Support Organization to support this study. Dr. Barbaro was supported by a T32 (HD007534) Grant funded by the Eunice Kennedy Shriver National Institute for Child Health and Human Development, for which Dr. Davis was the principal investigator.
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