Description

Honda et al reported a score for predicting respiratory complications for a child with a mediastinal tumor. The authors are from Saitama Children's Medical Center in Japan.


Patient selection: child with mediastinal tumor

 

Respiratory complications may include: SpO2 < 70% on room air; difficult ventilation; respiratory failure; cardiopulmonary arrest

 

Parameters:

(1) cough

(2) wheeze

(3) hypoxia

(4) orthopnea

(5) dyspnea

(6) stridor

(7) compression of carina

(8) minimum percent of tracheal cross-sectional area (at point of compression)

 

Parameter

Finding

Points

cough

no

0

 

yes

1

wheeze

no

0

 

yes

1

hypoxia

no

0

 

yes

1

orthopnea

no

0

 

yes

1

dyspnea

no

0

 

yes

1

stridor

no

0

 

yes

2

compression of carina

no

0

 

yes

2

percent of tracheal compression

>= 50%

0

 

< 50%

3

 

total score =

= SUM(points for all of the parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 12

 

Total Score

Risk Category for Respiratory Complications

0 or 1

low

2 to 6

intermediate

7 to 12

high

 

The risk category can help guide management.

 

Action

Low Risk

Intermediate Risk

High Risk

general anesthesia

safe

probably safe but variable

unsafe (high risk of complications)

start of therapy

wait for biopsy

variable

start before biopsy

intubation

safe but may not be necessary

variable

perform awake in case of emergency

ECMO

NA

NA

consider use

biopsy

under general anesthesia

under local if possible else genral

under local anesthesia

 

Performance:

• A score >= 7 has a sensitivity and specificity of 100% for respiratory complications


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