BACKGROUND/ PURPOSE: Disease-specific outcome predictors are required for gastroschisis. We derived and validated a gastroschisis prognostic score (GPS) based on bowel appearance after birth. METHODS: Visual scoring of bowel matting, necrosis, atresia, and perforation generated a novel gastroschisis bowel injury score recorded in a national database. Reweighting of score components by regression analysis led to assessments of model calibration and goodness of fit. The GPS was validated in subsequent cases. RESULTS: Records from 225 infants were used for model derivation. Only intestinal necrosis independently predicted mortality by regression analysis (odds ratio, 11.5; 95% confidence interval, 4.2-31.4). Model recalibration identified that a GPS of 4 or more predicted mortality in 75% of nonsurvivors and 99% of survivors (P = .0001). A GPS of 2 or more demonstrated significantly worse survival outcomes compared with scores of 0 or 1 (length of stay: P = .011, days to first enteral feed: P = .013, days on total parenteral nutrition: P = .006). Model validation with 184 new patients yielded continued high-quality discrimination of outcomes. The GPS demonstrated "near-perfect" interobserver reliability between 2 surgeons (κ ≥ 0.86). CONCLUSIONS: The GPS allows the accurate and reliable identification of high-risk groups for mortality and morbidity based on bowel appearance at birth. This information can drive discussions regarding family counseling, resource allocation, and new therapies for these patients.
BACKGROUND/ PURPOSE: Disease-specific outcome predictors are required for gastroschisis. We derived and validated a gastroschisis prognostic score (GPS) based on bowel appearance after birth. METHODS: Visual scoring of bowel matting, necrosis, atresia, and perforation generated a novel gastroschisis bowel injury score recorded in a national database. Reweighting of score components by regression analysis led to assessments of model calibration and goodness of fit. The GPS was validated in subsequent cases. RESULTS: Records from 225 infants were used for model derivation. Only intestinal necrosis independently predicted mortality by regression analysis (odds ratio, 11.5; 95% confidence interval, 4.2-31.4). Model recalibration identified that a GPS of 4 or more predicted mortality in 75% of nonsurvivors and 99% of survivors (P = .0001). A GPS of 2 or more demonstrated significantly worse survival outcomes compared with scores of 0 or 1 (length of stay: P = .011, days to first enteral feed: P = .013, days on total parenteral nutrition: P = .006). Model validation with 184 new patients yielded continued high-quality discrimination of outcomes. The GPS demonstrated "near-perfect" interobserver reliability between 2 surgeons (κ ≥ 0.86). CONCLUSIONS: The GPS allows the accurate and reliable identification of high-risk groups for mortality and morbidity based on bowel appearance at birth. This information can drive discussions regarding family counseling, resource allocation, and new therapies for these patients.
Authors: Pastor Escarcega-Fujigaki; Guillermo Hernandez-Peredo-Rezk; Naomi J Wright; Ahtziri Del Carmen Cardenas-Paniagua; Haydee Velez-Blanco; Celine Gutierrez-Canencia; Lorenzo Saavedra-Velez; Berenice Venegas-Espinoza; Jose Luis Diaz-Luna; Miguel Castro-Ramirez Journal: World J Surg Date: 2021-10-21 Impact factor: 3.352
Authors: C C M M Lap; L R Pistorius; E J H Mulder; M Aliasi; W L M Kramer; C M Bilardo; T E Cohen-Overbeek; E Pajkrt; D Tibboel; R M H Wijnen; G H A Visser; G T R Manten Journal: Ultrasound Obstet Gynecol Date: 2020-06 Impact factor: 7.299
Authors: Asta Tauriainen; Arimatias Raitio; Tuomas Tauriainen; Kari Vanamo; Ulla Sankilampi; Ilkka Helenius; Anna Hyvärinen Journal: Pediatr Surg Int Date: 2022-07-26 Impact factor: 2.003