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
Specialty: Hematology Oncology