External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery
Objective Independent temporal external validation of the improving partial risk adjustment in surgery model (PRAIS-2) to predict 30-day mortality in patients undergoing paediatric cardiac surgery.Design Retrospective analysis of prospectively collected data.Setting Paediatric cardiac surgery.Interv...
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BMJ Publishing Group
2020-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/11/e039236.full |
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| author | Massimo Caputo Lucia Cocomello Rosie Cornish Deborah Lawlor |
| author_facet | Massimo Caputo Lucia Cocomello Rosie Cornish Deborah Lawlor |
| author_sort | Massimo Caputo |
| collection | DOAJ |
| description | Objective Independent temporal external validation of the improving partial risk adjustment in surgery model (PRAIS-2) to predict 30-day mortality in patients undergoing paediatric cardiac surgery.Design Retrospective analysis of prospectively collected data.Setting Paediatric cardiac surgery.Intervention PRAIS-2 validation was carried out using a two temporally different single centre (Bristol, UK) cohorts: Cohort 1 surgery undertaken from April 2004 to March 2009 and Cohort 2 from April 2015 to July 2019. For each subject PRAIS-2 score was calculated according to the original formula.Participants A total of 1352 (2004-2009) and 1197 (2015-2019) paediatric cardiac surgical procedures were included in the Cohort 1 and Cohort 2, respectively (median age at the procedure 6.3 and 7.1 months).Primary and secondary outcome measures PRAIS-2 performance was assessed in terms of discrimination by means of ROC (receiver operating characteristic) curve analysis and calibration by using the calibration belt method.Results PRAIS-2 score showed excellent discrimination for both cohorts (AUC 0.72 (95%CI: 0.65 to 0.80) and 0.88 (95%CI: 0.82 to 0.93), respectively). While PRAIS-2 was only marginally calibrated in Cohort 1, with a tendency to underestimate risk in lowrisk and overestimate risk in high risk procedures (P-value = 0.033), validation in Cohort 2 showed good calibration with the 95% confidence belt containing the bisector for predicted mortality (P-value = 0.143). We also observed good prediction accuracy in the non-elective procedures (N = 483;AUC 0.78 (95%CI 0.68 to 0.87); Calibration belt containing the bisector (P-value=0.589).Conclusions In a single centre UK-based cohort, PRAIS-2 showed excellent discrimination and calibration in predicting 30-day mortality in paediatric cardiac surgery including in those undergoing non-elective procedures. Our results support a wider adoption of PRAIS-2 score in the clinical practice. |
| format | Article |
| id | doaj-art-aacb37bd6fa3419cb713b6fac8bfee5f |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-aacb37bd6fa3419cb713b6fac8bfee5f2025-08-20T02:22:40ZengBMJ Publishing GroupBMJ Open2044-60552020-11-01101110.1136/bmjopen-2020-039236External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgeryMassimo Caputo0Lucia Cocomello1Rosie Cornish2Deborah Lawlor3Bristol Heart Institute, University of Bristol, Bristol, UKMRC Integrative Epidemiology Unit, University of Bristol, Bristol, UKPopulation Health Science, Bristol Medical School University of Bristol, Bristol, United KingdomNIHR Bristol Biomedical Research Centre, Bristol, UKObjective Independent temporal external validation of the improving partial risk adjustment in surgery model (PRAIS-2) to predict 30-day mortality in patients undergoing paediatric cardiac surgery.Design Retrospective analysis of prospectively collected data.Setting Paediatric cardiac surgery.Intervention PRAIS-2 validation was carried out using a two temporally different single centre (Bristol, UK) cohorts: Cohort 1 surgery undertaken from April 2004 to March 2009 and Cohort 2 from April 2015 to July 2019. For each subject PRAIS-2 score was calculated according to the original formula.Participants A total of 1352 (2004-2009) and 1197 (2015-2019) paediatric cardiac surgical procedures were included in the Cohort 1 and Cohort 2, respectively (median age at the procedure 6.3 and 7.1 months).Primary and secondary outcome measures PRAIS-2 performance was assessed in terms of discrimination by means of ROC (receiver operating characteristic) curve analysis and calibration by using the calibration belt method.Results PRAIS-2 score showed excellent discrimination for both cohorts (AUC 0.72 (95%CI: 0.65 to 0.80) and 0.88 (95%CI: 0.82 to 0.93), respectively). While PRAIS-2 was only marginally calibrated in Cohort 1, with a tendency to underestimate risk in lowrisk and overestimate risk in high risk procedures (P-value = 0.033), validation in Cohort 2 showed good calibration with the 95% confidence belt containing the bisector for predicted mortality (P-value = 0.143). We also observed good prediction accuracy in the non-elective procedures (N = 483;AUC 0.78 (95%CI 0.68 to 0.87); Calibration belt containing the bisector (P-value=0.589).Conclusions In a single centre UK-based cohort, PRAIS-2 showed excellent discrimination and calibration in predicting 30-day mortality in paediatric cardiac surgery including in those undergoing non-elective procedures. Our results support a wider adoption of PRAIS-2 score in the clinical practice.https://bmjopen.bmj.com/content/10/11/e039236.full |
| spellingShingle | Massimo Caputo Lucia Cocomello Rosie Cornish Deborah Lawlor External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery BMJ Open |
| title | External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery |
| title_full | External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery |
| title_fullStr | External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery |
| title_full_unstemmed | External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery |
| title_short | External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery |
| title_sort | external validation of the improving partial risk adjustment in surgery prais 2 model for 30 day mortality after paediatric cardiac surgery |
| url | https://bmjopen.bmj.com/content/10/11/e039236.full |
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