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Predicting neonatal mortality among very preterm infants: a comparison of three versions of the CRIB score
  1. B N Manktelow1,
  2. E S Draper1,
  3. D J Field2
  1. 1
    Department of Health Sciences, University of Leicester, Leicester, UK
  2. 2
    Neonatal Unit, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to Bradley N Manktelow, Department of Health Sciences, 22-28 Princess Road West, Leicester LE1 6TP, UK; brad.manktelow{at}le.ac.uk

Abstract

Objective: To validate Clinical Risk Index for Babies (CRIB) and CRIB II mortality prediction scores in a UK population of infants born at ⩽32 weeks’ gestation, and investigate CRIB II calculated without admission temperature.

Methods: Infants born at 22–32 weeks’ gestation to mothers resident in a UK region in 2005–2006 admitted for neonatal care were identified. Predictive probabilities for mortality were calculated using CRIB, CRIB II and CRIB II without admission temperature (CRIB II(-T)) using published algorithms and after recalibration.

Predictive performance was investigated overall and for groups defined by gestation and admission temperature and summarised by area under receiver-operating curve, Cox’s regression, Brier scores and Spiegelhalter’s z-scores.

Results: 3268 infants were included: 317 (9.7%) died before discharge. Using published algorithms each score showed excellent discrimination (area under the curve = 0.92). The total number of deaths was predicted well for CRIB (324.4) but for both versions of CRIB II the number of deaths was underpredicted (255.2 and 216.6). All scores performed poorly for subgroups.

After recalibration CRIB II displayed excellent predictive characteristics overall (Spiegelhalter’s z-score p = 0.52) and in the gestation groups (p = 0.44 and 0.57) but not for the temperature groups (p = 0.026 and 0.97). CRIB II(-T) displayed excellent predictive characteristics for all groups: overall p = 0.53; gestation groups p = 0.64 and 0.42; temperature groups p = 0.42 and 0.66.

Conclusions: The published algorithm for CRIB II was poorly calibrated but simple linear recalibration provided good results. The CRIB II score without admission temperature showed good predictive characteristics once recalibrated and this version of the score should be used when benchmarking mortality in neonatal intensive care units.

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Footnotes

  • Funding The Neonatal Survey is one of the Infant Mortality and Morbidity Studies, which are funded by the Primary Care Trusts of the East Midlands and Yorkshire.

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

  • Ethics approval The Neonatal Survey has multicentre research and Patient Information Advisory Group (Section 60 of the Health and Social Care Act, 2001) approvals in place.

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