| The gastroschisis prognostic score: reliable outcome prediction in gastroschisis. | |
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MedLine Citation:
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PMID: 22703779 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND/PURPOSE: Disease-specific outcome predictors are required for gastroschisis. We derived and validated a gastroschisis prognostic score (GPS) based on bowel appearance after birth. METHODS: Visual scoring of bowel matting, necrosis, atresia, and perforation generated a novel gastroschisis bowel injury score recorded in a national database. Reweighting of score components by regression analysis led to assessments of model calibration and goodness of fit. The GPS was validated in subsequent cases. RESULTS: Records from 225 infants were used for model derivation. Only intestinal necrosis independently predicted mortality by regression analysis (odds ratio, 11.5; 95% confidence interval, 4.2-31.4). Model recalibration identified that a GPS of 4 or more predicted mortality in 75% of nonsurvivors and 99% of survivors (P = .0001). A GPS of 2 or more demonstrated significantly worse survival outcomes compared with scores of 0 or 1 (length of stay: P = .011, days to first enteral feed: P = .013, days on total parenteral nutrition: P = .006). Model validation with 184 new patients yielded continued high-quality discrimination of outcomes. The GPS demonstrated "near-perfect" interobserver reliability between 2 surgeons (κ ≥ 0.86). CONCLUSIONS: The GPS allows the accurate and reliable identification of high-risk groups for mortality and morbidity based on bowel appearance at birth. This information can drive discussions regarding family counseling, resource allocation, and new therapies for these patients. |
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Authors:
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Kyle N Cowan; Pramod S Puligandla; Jean-Martin Laberge; Erik D Skarsgard; Sarah Bouchard; Natalie Yanchar; Peter Kim; Shoo Lee; Douglas McMillan; Peter von Dadelszen; |
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Publication Detail:
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Type: JOURNAL ARTICLE |
Journal Detail:
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Title: Journal of pediatric surgery Volume: 47 ISSN: 1531-5037 ISO Abbreviation: - Publication Date: 2012 Jun |
Date Detail:
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Created Date: 2012-6-18 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0052631 Medline TA: J Pediatr Surg Country: - |
Other Details:
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Languages: ENG Pagination: 1111-1117 Citation Subset: - |
Copyright Information:
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Copyright © 2012 Elsevier Inc. All rights reserved. |
Affiliation:
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Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada K1H 8L1. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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