title: Development of a likelihood of survival scoring system for hospitalized equine neonates using generalized boosted regression modeling.
abstract: BACKGROUND
  Medical management of critically ill equine neonates (foals) can be expensive and labor intensive. Predicting the odds of foal survival using clinical information could facilitate the decision-making process for owners and clinicians. Numerous prognostic indicators and mathematical models to predict outcome in foals have been published; however, a validated scoring method to predict survival in sick foals has not been reported. The goal of this study was to develop and validate a scoring system that can be used by clinicians to predict likelihood of survival of equine neonates based on clinical data obtained on admission.
  
  
  RESULTS
  Data from 339 hospitalized foals of less than four days of age admitted to three equine hospitals were included to develop the model. Thirty seven variables including historical information, physical examination and laboratory findings were analyzed by generalized boosted regression modeling (GBM) to determine which ones would be included in the survival score. Of these, six variables were retained in the final model. The weight for each variable was calculated using a generalized linear model and the probability of survival for each total score was determined. The highest (7) and the lowest (0) scores represented 97% and 3% probability of survival, respectively. Accuracy of this survival score was validated in a prospective study on data from 283 hospitalized foals from the same three hospitals. Sensitivity, specificity, positive and negative predictive values for the survival score in the prospective population were 96%, 71%, 91%, and 85%, respectively.
  
  
  CONCLUSIONS
  The survival score developed in our study was validated in a large number of foals with a wide range of diseases and can be easily implemented using data available in most equine hospitals. GBM was a useful tool to develop the survival score. Further evaluations of this scoring system in field conditions are needed.
authors.affiliation: College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Katarzyna A
authors.initials: KA
authors.lastname: Dembek
authors.affiliation: College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Hurcombe
authors.affiliation: Hagyard Equine Medical Institute, Lexington, Kentucky, United States of America.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Frazer
authors.affiliation: Rood and Riddle Equine Hospital, Lexington, Kentucky, United States of America.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Morresey
authors.affiliation: College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Ramiro E
authors.initials: RE
authors.lastname: Toribio
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D016638:Critical Illness; D005260:Female; D006734:Horse Diseases / Q000401:mortality*; D006736:Horses; D006760:Hospitalization / Q000706:statistics & numerical data; D008297:Male; D008962:Models, Theoretical; D011446:Prospective Studies