An illness severity score and neonatal mortality in retrieved neonates.
The Clinical Risk Index for Babies (CRIB) score is a simple tool to measure clinical risk and illness severity in very low birth weight infants. The aim of this study was to determine if a modified CRIB score (MCRIB) used at first telephone contact with a transport service differentiated between retrieved infants who did or did not die in the neonatal period and hence might be a useful triage tool. A retrospective cohort study of 2504 infants, median gestational age 36 weeks and birth weight 2782 g, transported by the New South Wales Newborn and Paediatric Emergency Transport Service (NETS) was performed. MCRIB was calculated at four time points during the retrieval process. The MCRIB score at the time of the first call and the change in the MCRIB score over the retrieval process were related to outcome (neonatal death or survival). The mean MCRIB score at the time of first call was higher in those infants who died during the neonatal period (4.37) than in those who survived (2.63), (P < 0.0001). MCRIB performed better (area under the receiver operator characteristic curves of 0.72) with regard to predicting mortality than gestational age (0.56) or birth weight (0.52). The mean MCRIB score fell progressively from the time of first call to admission at the accepting NICU (P < 0.0001); infants whose MCRIB score increased were more likely to die (P < 0.0001).


CONCLUSIONS
these results suggest an illness severity score, applied at the time of first call to a transport service would be helpful in setting priorities for retrievals.
Broughton
Simon J
SJ
Department of Child Health, Guy's King's and St Thomas' School of Medicine, King's College Hospital, 4th Floor Golden Jubilee Wing, Bessemer Road, SE5 9RS London, UK.
Berry
Andrew
A
Jacobe
Stephen
S
Cheeseman
Paul
P
Tarnow-Mordi
William O
WO
Greenough
Anne
A
D000704:Analysis of Variance; D001724:Birth Weight; D005260:Female; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index