Development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients: the VPOP score.
BACKGROUND
Few data are available in the literature on risk factors for postoperative vomiting (POV) in children.


OBJECTIVE
The aim of the study was to establish independent risk factors for POV and to construct a pediatric specific risk score to predict POV in children.


METHODS
Characteristics of 2392 children operated under general anesthesia were recorded. The dataset was randomly split into an evaluation set (n = 1761), analyzed with a multivariate analysis including logistic regression and backward stepwise procedure, and a validation set (n = 450), used to confirm the accuracy of prediction using the area under the receiver operating characteristic curve (ROCAUC ), to optimize sensitivity and specificity.


RESULTS
The overall incidence of POV was 24.1%. Five independent risk factors were identified: stratified age (>3 and <6 or >13 years: adjusted OR 2.46 [95% CI 1.75-3.45]; ≥6 and ≤13 years: aOR 3.09 [95% CI 2.23-4.29]), duration of anesthesia (aOR 1.44 [95% IC 1.06-1.96]), surgery at risk (aOR 2.13 [95% IC 1.49-3.06]), predisposition to POV (aOR 1.81 [95% CI 1.43-2.31]), and multiple opioids doses (aOR 2.76 [95% CI 2.06-3.70], P < 0.001). A simplified score was created, ranging from 0 to 6 points. Respective incidences of POV were 5%, 6%, 13%, 21%, 36%, 48%, and 52% when the risk score ranged from 0 to 6. The model yielded a ROCAUC of 0.73 [95% CI 0.67-0.78] when applied to the validation dataset.


CONCLUSIONS
Independent risk factors for POV were identified and used to create a new score to predict which children are at high risk of POV.
Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire Necker - Enfants Malades, AP-HP, University Paris Descartes, Paris, France.
Nathalie
N
Bourdaud
Jean-Michel
JM
Devys
Jocelyne
J
Bientz
Corinne
C
Lejus
Anne
A
Hebrard
Olivier
O
Tirel
Damien
D
Lecoutre
Nada
N
Sabourdin
Yves
Y
Nivoche
Catherine
C
Baujard
Lydia
L
Nikasinovic
Gilles A
GA
Orliaguet
D000293:Adolescent; D000367:Age Factors; D000701:Analgesics, Opioid; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020250:Postoperative Nausea and Vomiting / Q000175:diagnosis* / Q000453:epidemiology*; D011336:Probability; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012306:Risk; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors; D013997:Time Factors
D000701:Analgesics, Opioid
pediatrics; postoperative nausea and vomiting; risk factors