Derivation of candidate clinical decision rules to identify infants at risk for central apnea

Paul Walsh, Pádraig Cunningham, Sabrina Merchant, Nicholas Walker, Jacquelyn Heffner, Lucas Shanholtzer, Stephen J. Rothenberg

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVES: Central apnea complicates, and may be the presenting complaint in, bronchiolitis. Our objective was to prospectively derive candidate clinical decision rules (CDRs) to identify infants in the emergency department (ED) who are at risk for central apnea. METHODS: We conducted a prospective observational study over 8 years. The primary outcome was central apnea subsequent to the initial ED visit. Infants were enrolled if they presented with central apnea or bronchiolitis. We excluded infants with obstructive apnea, neonatal jaundice, trauma, or suspected sepsis. We developed 3 candidate CDRs by using 3 techniques: (1) Poisson regression clustered on the individual, (2) classification and regression tree analysis (CART), and (3) a random forest (RF). RESULTS: We analyzed 990 ED visits for 892 infants. Central apnea subsequently occurred in the hospital in 41 (5%) patients. Parental report of apnea, previous history of apnea, congenital heart disease, birth weight ≤2.5 kg, lower weight, and age ≤6 weeks all identified a group at high risk for subsequent central apnea. All CDRs and RFs were 100% sensitive (95% confidence interval [CI] 91%-100%) and had a negative predictive value of 100% (95% CI 99%-100%) for the subsequent apnea. Specificity ranged from 61% to 65% (95% CI 58%-68%) for CDRs based on Poisson models; 65% to 77% (95% CI 62%-90%) for CART; and 81% to 91% (95% CI 78%-92%) for RF models. CONCLUSIONS: All candidate CDRs had a negative predictive value of 100% for subsequent central apnea.

Original languageEnglish (US)
Pages (from-to)e1298-e1306
JournalPediatrics
Volume136
Issue number5
DOIs
StatePublished - Nov 1 2015

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Fingerprint Dive into the research topics of 'Derivation of candidate clinical decision rules to identify infants at risk for central apnea'. Together they form a unique fingerprint.

  • Cite this

    Walsh, P., Cunningham, P., Merchant, S., Walker, N., Heffner, J., Shanholtzer, L., & Rothenberg, S. J. (2015). Derivation of candidate clinical decision rules to identify infants at risk for central apnea. Pediatrics, 136(5), e1298-e1306. https://doi.org/10.1542/peds.2015-1825