SNAP-II predicts mortality among infants with congenital diaphragmatic hernia.
OBJECTIVE
Outcomes analysis in congenital diaphragmatic hernia (CDH) requires a validated risk-adjustment tool. The purpose of this study was to use the Canadian Neonatal Network (CNN) database to validate the Score for Neonatal Acute Physiology, Version II (SNAP-II) for prediction of mortality among CDH infants admitted to a neonatal intensive care unit (NICU), and to compare this to the predictive equation recently developed by the Congenital Diaphragmatic Hernia Study Group (CDHSG).


METHODS
Infants with CDH in the CNN database were identified. Bivariate and multivariable logistic regression models were used to identify risk factors predictive of mortality. Model predictive performance and calibration were assessed using the area under the receiver operator characteristic curve and the technique of Hosmer-Lemeshow, respectively, and compared with the CDHSG predictive equation.


RESULTS
There were 88 patients with CDH among 19,507 admissions to CNN hospitals. The mortality rate among CDH patients surviving to NICU admission was 17%, and 12.5% received extracorporeal membrane oxygenation therapy. Gestational age and admission SNAP-II score predicted mortality. Model predictive performance and calibration were optimized with these variables combined. The CDHSG equation was equally predictive of mortality, but was only marginally calibrated.


CONCLUSIONS
SNAP-II is highly predictive of mortality among patients with CDH, and can be used to risk-adjust these patients.
Skarsgard
Erik D
ED
Department of Surgery, Children's and Women's Health Centre of British Columbia, the University of British Columbia, Vancouver, B.C., Canada.
MacNab
Ying C
YC
Qiu
Zhenguo
Z
Little
Ruth
R
Lee
Shoo K
SK
D002423:Cause of Death; D015331:Cohort Studies; D003422:Critical Care / Q000592:standards / Q000639:trends; D005260:Female; D006305:Health Status Indicators; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D009864:Ontario; D011336:Probability; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D014505:Urban Population