The Development and Validation of a Risk Score to Predict the Probability of Postoperative Vomiting in Pediatric Patients

TLDR

Adult postoperative vomiting risk scores are unsuitable for children because key factors such as smoking status are irrelevant or hard to assess. The study aimed to develop and validate a simple pediatric postoperative vomiting risk score (POVOC‑score). Using data from 1,257 children across four institutions, the authors recorded pre‑operative risk factors, monitored vomiting for 24 h, and built a logistic regression model on an evaluation set (657) that was then validated on 600 patients, yielding an AUC. Four factors—surgery ≥30 min, age ≥3 yr, strabismus surgery, and personal or family history of vomiting—predicted PV with an AUC of 0.72, and the score’s risk categories ranged from 9 % to 70 % incidence, demonstrating acceptable predictive accuracy.

Abstract

Risk scores to predict the occurrence of postoperative vomiting (PV) or nausea and vomiting that were developed for adult patients do not fit for children, because several risk factors are difficult to assess or are usually not applicable in pediatric patients (e.g., smoking status). Thus, in the present study, we sought to develop and to validate a simple score to predict PV in children (POVOC-score). Development and validation of the new score was based on data from 4 independent institutions of 1257 children (aged 0-14 yr) undergoing various types of surgery under general anesthesia without antiemetic prophylaxis. Preoperatively, several potential risk factors were recorded. Postoperatively, the occurrence of PV was observed for up to 24 h. The dataset was randomly split into an evaluation set (n = 657) that was analyzed using a forward logistic regression technique and a validation set (n = 600) that was used to confirm the accuracy of prediction by means of the area under a receiver operating characteristic curve. Four independent risk factors for PV were identified in the final analysis: duration of surgery >/=30 min, age >/=3 yr, strabismus surgery, and a positive history of PV in the children or PV/postoperative nausea and vomiting in relatives (mother, father, or siblings). The incidence of PV was 9%, 10%, 30%, 55%, and 70% for 0, 1, 2, 3, and 4 risk factors observed. Using these incidences as cut-off values in the validation dataset, the area under the receiver operating characteristic curve was 0.72 (95% confidence interval: 0.68-0.77). Our data suggest that PV can be predicted with an acceptable accuracy using a four-item simplified risk score.