简化通用儿科术前麻醉筛查：NSQIP数据分析评估NARCO评分作为儿科麻醉风险分层工具

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-02-18 DOI:10.1016/j.jpedsurg.2025.162248

Gillian Michaelson , Lucille Hu , Shelley Ohliger , Anuja Sarode , Eiichi Miyasaka , Anne K. Mackow

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引用次数: 0

摘要

背景：普遍的术前麻醉筛查对医院和患者来说可能是资源限制和负担。然而，如果没有风险分层的基础，就无法确定麻醉风险最大的患者。目的：本研究探讨改良版的神经、气道、呼吸、心血管和其他（NARCO）儿科术前风险评分是否可以将患者分为高、低麻醉风险组，并预测围手术期不良事件。方法采用美国外科医师学会国家手术质量改进计划（2019 ACS NSQIP-P®）儿科数据库中的132,881条记录进行回顾性队列研究。记录的合并症被分配NARCO分类和基于非颗粒数据的推定NARCO评分。使用了两种方法——一种方法将非颗粒性合并症视为高风险（高估了高风险组），另一种方法将这些合并症视为低风险（高估了低风险组）。采用卡方分析或Wilcoxon-Mann-Whitney分析(p <；0.05)。结果当比较NARCO和ASA评分时，两种方法都准确地反映了对高风险或低风险患者的高估。在两种方法中，24例不良事件中有23例的发生率显著(p <；0.05)，与高危人群相关。结论改进后的NARCO术前风险评估可以根据非颗粒性患者数据将儿童患者分为高危组和低危组。在这两种方法中，这种分层识别围手术期不良事件风险最高的患者，这是需要更密集的术前筛查的标志。研究类型：回顾性队列研究，使用来自大型。证据水平3。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Simplifying Universal Pediatric Pre-operative Anesthesia Screening: Analysis of NSQIP Data to Evaluate the NARCO Score as a Tool for Pediatric Anesthesia Risk Stratification

Background

Universal pre-operative anesthesia screening may be resource-prohibitive and burdensome to hospitals and patients. However, patients at greatest anesthetic risk cannot be identified without some basis for risk-stratification.

Aims

This study investigated if a modified version of the Neurological, Airway, Respiratory, Cardiovascular, and Other (NARCO) pre-surgical pediatric risk score could stratify patients into high- and low-anesthetic-risk groups that would be predictive of perioperative adverse events.

Methods

A retrospective cohort study was conducted using 132,881 records from the pediatric database of the American College of Surgeons National Surgical Quality Improvement Program (2019 ACS NSQIP-P®). Recorded comorbidities were assigned NARCO categories and presumptive NARCO scores based on non-granular data. Two methodologies were used--one in which non-granular comorbidities were considered high-risk (overestimating the high-risk group) and another in which these were considered low-risk (overestimating the low-risk group). These groups were evaluated by demographic and adverse outcome data using chi-square or Wilcoxon-Mann-Whitney analyses (p < 0.05).

Results

Both methodologies accurately reflected overestimation of high- or low-risk patients, when comparing NARCO to ASA scores. In both methodologies, the occurrences of 23 of 24 adverse events were significantly (p < 0.05) associated with the high-risk group.

Conclusion

A modified version of the NARCO pre-surgical risk assessment can stratify pediatric patients into high- and low-risk groups based on non-granular patient data. In both methodologies, this stratification identifies patients at highest risk for perioperative adverse events, which is a marker for those who require more intensive pre-surgical screening.

Type of study

Retrospective cohort study using de-identified information from a large.

Level of evidence

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.