title: A clinical prediction rule for the severity of congenital diaphragmatic hernias in newborns.
abstract: BACKGROUND
  Congenital diaphragmatic hernia (CDH) is a condition with a highly variable outcome. Some infants have a relatively mild disease process, whereas others have significant pulmonary hypoplasia and hypertension. Identifying high-risk infants postnatally may allow for targeted therapy.
  
  
  METHODS
  Data were obtained on 2202 infants from the Congenital Diaphragmatic Hernia Study Group database from January 2007 to October 2011. Using binary baseline predictors generated from birth weight, 5-minute Apgar score, congenital heart anomalies, and chromosome anomalies, as well as echocardiographic evidence of pulmonary hypertension, a clinical prediction rule was developed on a randomly selected subset of the data by using a backward selection algorithm. An integer-based clinical prediction rule was created. The performance of the model was validated by using the remaining data in terms of calibration and discrimination.
  
  
  RESULTS
  The final model included the following predictors: very low birth weight, absent or low 5-minute Apgar score, presence of chromosomal or major cardiac anomaly, and suprasystemic pulmonary hypertension. This model discriminated between a population at high risk of death (∼50%) intermediate risk (∼20%), or low risk (<10%). The model performed well, with a C statistic of 0.806 in the derivation set and 0.769 in the validation set and good calibration (Hosmer-Lemeshow test, P = .2).
  
  
  CONCLUSIONS
  A simple, generalizable scoring system was developed for CDH that can be calculated rapidly at the bedside. Using this model, intermediate- and high-risk infants could be selected for transfer to high-volume centers while infants at highest risk could be considered for advanced medical therapies.
authors.affiliation: Department of Surgery, University of Calgary, Calgary, Alberta, Canada; maryebrindle@gmail.com.
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Brindle
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts;
authors.forename: Earl Francis
authors.initials: EF
authors.lastname: Cook
authors.affiliation: Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; and.
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.affiliation: Department of Pediatric Surgery, Utah Health Medical School and Children's Memorial Hermann Hospital, Houston, Texas.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Lally
authors.affiliation: Department of Pediatric Surgery, Utah Health Medical School and Children's Memorial Hermann Hospital, Houston, Texas.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
mesh_terms: D001034:Apgar Score; D015897:Comorbidity; D003661:Decision Support Techniques; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000453:epidemiology; D007231:Infant, Newborn; D008297:Male; D018570:Risk Assessment; D012720:Severity of Illness Index; D014463:Ultrasonography
keywords: clinical prediction; congenital diaphragmatic hernia; population-based; survival