Transport Risk Index of Physiologic Stability, Version II (TRIPS-II): A Simple and Practical Neonatal Illness Severity Score

Abstract

Objective Derive and validate a practical assessment of infant illness severity at admission to neonatal intensive care units (NICUs).

Study Design Prospective study involving 17,075 infants admitted to 15 NICUs in 2006 to 2008. Logistic regression was used to derive a prediction model for mortality comprising four empirically weighted items (temperature, blood pressure, respiratory status, response to noxious stimuli). This Transport Risk Index of Physiologic Stability, version II (TRIPS-II) was then validated for prediction of 7-day and total NICU mortality.

Results TRIPS-II discriminated 7-day (receiver operating curve [ROC] area, 0.90) and total NICU mortality (ROC area, 0.87) from survival. Furthermore, there was a direct association between changes in TRIPS-II at 12 and 24 hours and mortality. There was good calibration across the full range of TRIPS-II scores and the gestational age at birth, and addition of TRIPS-II improved performance of prediction models that use gestational age and baseline population risk variables.

Conclusion TRIPS-II is a validated benchmarking tool for assessing infant illness severity at admission and for up to 24 hours after.

Keywords

neonates - mortality - risk adjustment - outcomes

Canadian Neonatal Network Site Investigators

Shoo K. Lee (Director, Canadian Neonatal Network); Prakesh Shah (Mount Sinai Hospital, Toronto, ON); Wayne Andrews (Janeway Children's Health and Rehabilitation Centre, Saint John's, NL); Francine Lefebvre (St. Justine's Hospital, Montreal, QC); Wendy Yee (Foothill's Hospital, Calgary, AB); Barbara Bullied (Everett Chalmers Hospital, Fredericton, NB); Rody Canning (Moncton Hospital, Moncton, NB); Gerarda Cronin (St. Boniface General Hospital, Winnipeg, MB); Kimberly Dow (Kingston General Hospital, Kingston, ON); Michael Dunn (Sunnybrook Health Sciences Centre, Toronto, ON); Suzanne Ferland (St. François d'Assise Hôpital, Québec City, QC); Adele Harrison (Victoria General Hospital, Victoria, BC); Andrew James (Hospital for Sick Children, Toronto, ON); Zarin Kalapesi (Regina General Hospital, Regina, SK); Lajos Kovacs (Jewish General Hospital, Montreal, QC); Jean Lachapelle (Hôpital Maisonneuve-Rosemont, Montréal, QC); David S. C. Lee (St. Joseph's Health Centre; London, ON); Douglas D. McMillan (IWK Health Centre, Halifax, NS); Cecil Ojah (Saint John Regional Hospital, Saint John, NB); Abraham Peliowski (Royal Alexandra Hospital, Edmonton, AB); Bruno Piedboeuf (Centre Hospitalier Universitaire de Quebec, Sainte Foy, QC); Patricia Riley (Montreal Children's Hospital, Montreal, QC); Daniel Faucher (Royal Victoria Hospital, Montreal, QC); Nicole Rouvinez-Bouali (Children's Hospital of Eastern Ontario, Ottawa, ON); Koravangattu Sankaran (Royal University Hospital, Saskatoon, SK); Mary Seshia (Health Sciences Centre, Winnipeg, MB); Sandesh Shivananda (Hamilton Health Sciences Centre, Hamilton, ON); Todd Sorokan (Royal Columbian Hospital, New Westminster, BC); Anne Synnes (Children's and Women's Health Centre of British Columbia, Vancouver, BC); Herve Walti (Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, QC)

Canadian Neonatal Network Coordinating Center (Toronto, ON): Priscilla Chan, M.Sc.; Sarah A. De La Rue, Ph.D.; Ruth Warre, Ph.D.; Xiang Y. Ye, M.Sc.; Woojin Yoon, M.Sc.

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