Publication:

A simple clinical score to predict outcome in hospitalized extramural neonates

Background Illness severity scores can guide to optimize the limited health care resources in developing nations. The aim of this study was to develop a clinical score for severity of illness to help prioritize care and predict outcome of neonates admitted in emergency department.

Methods Prospective hospital based observational study. Out of total 419 neonates who attended Emergency Department, 341 were included in the study. The neonates were screened for 20 clinical parameters at admission and a score of 0, 1 & 2 was assigned for each parameter depending upon severity. The outcome (death/discharge) was correlated with the study variables and total score. The predictive ability of score was calculated using Receiver Operating Characteristic curve (ROC) analysis. Every 10th case was also evaluated with Score for Neonatal Acute Physiology (SNAP) score and served as controls.

Results Of the 20 variables, 13 variables were found to be significantly associated with mortality. Mortality increased with the increase in the total score. The predictive ability of score calculated using ROC curve was 85.2. Maximum discrimination was observed at score of 17. The 36 control cases which were evaluated with SNAP score also had predictive value of 92.2. There was no statistically significant difference in the predictive values of Clinical Score and SNAP (P value >0.05).

Conclusions In emergency department, any sick neonate with clinical score 17 or more should be closely monitored and evaluated. These patients require admission as they have a potential risk of death.