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PEDIATRIC ANESTHESIA

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

L. H. J. Eberhart, MD^*, G. Geldner, MD^*, P. Kranke, MD, A. M. Morin, MD^*, A. Schäuffelen, MD, H. Treiber, MD, and H. Wulf, MD^*

*Department of Anesthesia and Intensive Care, Philipps-University, Marburg; Department of Anesthesiology and Intensive Care, University of Würzburg, Würzburg; and Ambulatory Surgical Center Söflingen, Ulm, Germany

Address correspondence and reprint requests to Leopold Eberhart, MD, Department of Anesthesia and Intensive Care, Philipps-University, Baldingerstr. 1, D-35033 Marburg, Germany. Address e-mail to eberhart{at}mailer.uni-marburg.de

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.

IMPLICATIONS: The incidence of postoperative vomiting might be predicted using duration of surgery 30 min, age 3 yr, strabismus surgery, and a positive history of postoperative vomiting/postoperative nausea and vomiting in the children or in their relatives. The predicted incidence of postoperative vomiting is 9%, 10%, 30%, 55%, and 70% for 0–4 of these risk factors present.

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