title: Could clinical scores guide the surgical treatment of necrotizing enterocolitis?
abstract: OBJECTIVE
  Test the diagnostic reliability of the score for neonatal acute physiology-perinatal extension-II (SNAPPE-II) and the metabolic derangement acuity score (MDAS) as predictors of surgery in patients with necrotizing enterocolitis (NEC).
  
  
  METHODS
  The SNAPPE-II and the MDAS were applied to 99 patients with NEC. Both the scores were calculated at the moment of diagnosis (T(0)) and when surgical assessment was required (T(1)). The main outcome was the need of surgical revision. Comparison between models was made through their receiver operator characteristics (ROC) curves.
  
  
  RESULTS
  Thirty-five patients required surgical treatment (group A) and 64 responded to medical therapy (group B). Median SNAPPE-II was 22 versus 5 for group A (U test 621, p = 0.002) at T(0); and 22 versus 10 for group A (U test 487, p = 0.01) at T(1). Measuring the value of the SNAPPE-II as a predictor of surgery, the ROC curve was 0.69 (CI 95%, 0.57-0.80) at T(0) and 0.67 (CI 95%, 0.55-0.80) at T(1). Median MDAS were 2 for both groups A and B at T(0) (U test 890.5, p = 0.113) and 2 versus 1.5 for group A at T(1) (U test 570, p = 0.043). The ROC curve for MDAS was 0.59 (CI 95%, 0.47-0.71) at T(0) and 0.64 (CI 95%, 0.52-0.77) at T(1).
  
  
  CONCLUSIONS
  The diagnostic performance of the SNAPPE-II offers mild results in the moment of the diagnosis of NEC, and at T(1). The MDAS is non significant at T(0) and obtains moderate results at T(1). These results do not encourage using the SNAPPE-II and the MDAS as definite tools to decide for surgical treatment of the patients affected by NEC.
authors: Hospital Infantil La Fe, Valencia, Spain.
authors: Vicente
authors: V
authors: Ibáñez
authors: Miguel
authors: M
authors: Couselo
authors: Verónica
authors: V
authors: Marijuán
authors: Juan José
authors: JJ
authors: Vila
authors: Carlos
authors: C
authors: García-Sala
mesh_terms: D003952:Diagnostic Imaging; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007813:Laparotomy / Q000379:methods / Q000592:standards*; D011336:Probability; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome