Development and Validation of a Neurological Outcome Prediction Score for Children Requiring Mechanical Ventilation: The NOPS-VC Score.

Abstract

Background and aims: Currently, no validated scoring system exists to predict neurological outcomes in mechanically ventilated children. We aimed to develop and validate such a score in this population.

Patients and methods: We developed the NOPS-VC score, comprising eight items. Each parameter is rated on a Likert scale, where a minimum score of 1 indicates no significant risk, and a maximum score of 3 represents the highest risk for poor neurological outcomes. The face and content validity of the score were assessed using the content validity index (CVI) and content validity ratio. Neurological outcomes were determined at discharge and at 6 months of follow-up. Construct validity was assessed by correlating the NOPS-VC score with the Pediatric Cerebral Performance Category score, functional status scale (FSS), intelligence quotient (IQ), Vineland Adaptive Behavior Scale, gross motor function measure (GMFM), child behavior checklist, and pediatric quality of life inventory.

Results: Among 170 participants, 87 had good functional outcomes. The scale-level content validity index (S-CVI/UA) was 0.95, and S-CVI/Ave was 0.9, indicating excellent content validity. The one-factor model demonstrated a good fit, with all item loadings exceeding 0.7 [Tucker-Lewis index (TLI) = 0.95, comparative fit index (CFI) = 0.96, root mean squared error of approximation (RMSEA) = 0.067 (0.059-0.074)]. The area under the receiver operating characteristic (ROC) curve for the maximum and baseline NOPS-VC scores was 0.92 and 0.91, respectively. The optimal cutoff value for both scores was 18, with sensitivity/specificity of 82/97% for the maximum score and 80/97% for the baseline score. Construct validity showed strong correlations (r ≥ 0.70) with all parameters.

Conclusion: The NOPS-VC score, when applied at the initiation of mechanical ventilation in critically ill children, demonstrates strong validity in predicting neurological outcomes at 6 months, with an optimal cutoff value of 18.

How to cite this article: Tomar A, Panda PK, Elwadhi A, Tiwari LK, Sharawat IK. Development and Validation of a Neurological Outcome Prediction Score for Children Requiring Mechanical Ventilation: The NOPS-VC Score. Indian J Crit Care Med 2025;29(7):578-585.