STBUR: Sleep trouble breathing and unrefreshed questionnaire: Evaluation of screening tool for postanesthesia care and disposition.

Autor: Galvez JA; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Yaport M; Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Maeder-Chieffo S; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Simpao AF; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Tan JM; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Wasey JO; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Lingappan AM; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Jablonka DH; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Subramanyam R; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Ahumada LM; Enterprise Analytics and Reporting, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Song B; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; College of Computing & Informatics, Drexel University, Philadelphia, Pennsylvania., Wu L; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Dubow S; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Rehman MA; Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Jazyk: angličtina
Zdroj: Paediatric anaesthesia [Paediatr Anaesth] 2019 Aug; Vol. 29 (8), pp. 821-828. Date of Electronic Publication: 2019 Jul 10.
DOI: 10.1111/pan.13660
Abstrakt: Background: The Snoring, Trouble Breathing, and Un-Refreshed (STBUR) questionnaire is a five-question screening tool for pediatric sleep-disordered breathing and risk for perioperative respiratory adverse events in children. The utility of this questionnaire as a preoperative risk-stratification tool has not been investigated. In view of limited availability of screening tools for preoperative pediatric sleep-disordered breathing, we evaluated the questionnaire's performance for postanesthesia adverse events that can impact postanesthesia care and disposition.
Methods: The retrospective study protocol was approved by the institutional research board. The data were analyzed using two different definitions for a positive screening based on a five-point scale: low threshold (scores 1 to 5) and high threshold (score of 5). The primary outcome was based on the following criteria: (a) supplemental oxygen therapy following postanesthesia care unit (PACU) stay until hospital discharge, (b) greater than two hours during phase 1 recovery, (c) anesthesia emergency activation in the PACU, and (d) unplanned hospital admission.
Results: About 6025 patients completed the questionnaire during the preoperative evaluation. And 1522 patients had a low threshold score and 270 had a high-threshold score. We found statistically significant associations in three outcomes based on the low threshold score: supplemental oxygen therapy (negative-predictive value [NPV] 0.97, 95% CI 0.97-98), PACU recovery time (NPV 0.99, 95% CI 0.99-0.99) and escalation of care (NPV 0.98, 95% CI 0.97-0.98). Positive-predictive values were statistically significant for all outcomes except anesthesia emergency in the PACU.
Conclusion: The Snoring, Trouble Breathing, and Un-Refreshed questionnaire identified patients at higher risk for prolonged phase 1 recovery, oxygen therapy requirement, and escalation of care. The questionnaire's high-negative predictive value and specificity may make it useful as a screening tool to identify patients at low risk for prolonged stay in PACU.
(© 2019 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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