title: Are Scores Reliable in Predicting the Need for Surgery and Mortality in Necrotizing Enterocolitis?
abstract: BackgroundManagement of children with necrotizing enterocolitis (NEC) remains challenging. Various scores try to facilitate therapeutic decision-making. We aim to assess the agreement of three scores intending to predict the need for surgery and/or mortality in our patient cohort, and analyze agreement between the different scores.MethodsThis study is a retrospective analysis of patients with NEC Bell's stage II and III, managed in a single institution (1991-2011). Three existing scores (Metabolic Derangement Acuity score, NEC score, Detroit score) were calculated individually for each patient. The agreement between predicted outcome by scores and real outcome was evaluated with kappa statistic.ResultsOf 57 children, 46% presented with NEC stage II, 54% with stage III, 46% were treated with surgery, 54% conservatively, and survival was 58%. The kappa indexes for "need for surgery" were 0.41, 0.13, and 0.12 and kappa indexes for "mortality" were 0.27, 0.04, and 0.1 for the Metabolic Derangement Acuity score, the NEC score, and the Detroit score, respectively.ConclusionIn our cohort, the agreement between the predicted outcomes by scores and the real need for surgery and/or mortality was poor. There was a lack of clinical usefulness of the tested scores. We must continue to better identify parameters to help guide the management of these patients.
authors.affiliation: Division of Pediatric Surgery, Geneva University Hospitals, University Center of Pediatric Surgery of Western Switzerland, Geneva, Switzerland.
authors.forename: Delphine
authors.initials: D
authors.lastname: Arni
authors.affiliation: Division of Neonatology and Pediatric Intensive Care, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Karam
authors.affiliation: Division of Pediatric Surgery, Geneva University Hospitals, University Center of Pediatric Surgery of Western Switzerland, Geneva, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vidal
authors.affiliation: Division of Neonatology and Pediatric Intensive Care, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rimensberger
authors.affiliation: Unit of Pediatric Radiology, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Sylviane
authors.initials: S
authors.lastname: Hanquinet
authors.affiliation: Division of Pediatric Surgery, Geneva University Hospitals, University Center of Pediatric Surgery of Western Switzerland, Geneva, Switzerland.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Wildhaber
mesh_terms: D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index