Hermansen et al developed a score to evaluate the transfer of very low birthweight neonates. This can help identify those neonates at greater risk for mortality. The authors are from Allegheny General Hospital in Pittsburgh and the University of Kentucky Medical Center in Lexington.
Parameters:
(1) blood glucose concentration
(2) systolic blood pressure
(3) pH
(4) pO2
(5) core body temperature in °C
|
Parameter |
Finding |
Points |
|
blood glucose in mg/dL |
< 25 mg/dL |
0 |
|
|
25 - 40 mg/dL |
1 |
|
|
41 - 175 mg/dL |
2 |
|
|
> 175 mg/dL |
1 |
|
systolic blood pressure in mm Hg |
< 30 mm Hg |
0 |
|
|
30 - 39 mm Hg |
1 |
|
|
>= 40 mm Hg |
2 |
|
pH |
< 7.20 |
0 |
|
|
7.20 - 7.29 |
1 |
|
|
7.30 - 7.45 |
2 |
|
|
7.46 - 7.50 |
1 |
|
|
> 7.50 |
0 |
|
pO2 in mm Hg |
< 40 mm Hg |
0 |
|
|
40 - 49 mm Hg |
1 |
|
|
50 - 100 mm Hg |
2 |
|
|
> 100 mm Hg |
1 |
|
core body temperature in °C |
< 36.1°C |
0 |
|
|
36.1 - 36.5°C |
1 |
|
|
36.6 - 37.2°C |
2 |
|
|
37.3 - 37.6°C |
1 |
|
|
> 37.7°C |
0 |
where:
• I need to clarify why a pO2 > 100 mm Hg has a reduced point assignment.
• pH and pO2 probably are arterial values.
• Blood glucose was done using reagent strips. I assume that these are whole blood values. Serum values would need to be adjusted.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score the better the chances of survival.
• A cutoff for high risk of death was set at a score < 8.
• I would be tempted to have 4 risk levels, with a score 10 as low risk, 8 or 9 intermediate risk, 5 to 7 high risk, and 0 to 4 fatal.
Performance:
• Using 8 as the cutoff gave a sensitivity of 62% with specificity of 81%.
• Outcomes were affected by the experience of the transport team.
• Over 15 years have passed since the score was proposed. Better care may have altered the outcome distribution.
Limitations:
• The only outcome measured was survival. A longer followup might be interesting, especially in the 5 to 8 point range.
Specialty: Critical Care, Emergency Medicine
ICD-10: ,
