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

Fingerprint

Central Sleep Apnea
Apnea
Confidence Intervals
Hospital Emergency Service
Bronchiolitis
Regression Analysis
Neonatal Jaundice
Birth Weight
Observational Studies
Heart Diseases
Sepsis
Prospective Studies
Weights and Measures
Wounds and Injuries

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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

Derivation of candidate clinical decision rules to identify infants at risk for central apnea. / Walsh, Paul; Cunningham, Pádraig; Merchant, Sabrina; Walker, Nicholas; Heffner, Jacquelyn; Shanholtzer, Lucas; Rothenberg, Stephen J.

In: Pediatrics, Vol. 136, No. 5, 01.11.2015, p. e1298-e1306.

Research output: Contribution to journalArticle

Walsh, P, Cunningham, P, Merchant, S, Walker, N, Heffner, J, Shanholtzer, L & Rothenberg, SJ 2015, 'Derivation of candidate clinical decision rules to identify infants at risk for central apnea', Pediatrics, vol. 136, no. 5, pp. e1298-e1306. https://doi.org/10.1542/peds.2015-1825
Walsh P, Cunningham P, Merchant S, Walker N, Heffner J, Shanholtzer L et al. Derivation of candidate clinical decision rules to identify infants at risk for central apnea. Pediatrics. 2015 Nov 1;136(5):e1298-e1306. https://doi.org/10.1542/peds.2015-1825
Walsh, Paul ; Cunningham, Pádraig ; Merchant, Sabrina ; Walker, Nicholas ; Heffner, Jacquelyn ; Shanholtzer, Lucas ; Rothenberg, Stephen J. / Derivation of candidate clinical decision rules to identify infants at risk for central apnea. In: Pediatrics. 2015 ; Vol. 136, No. 5. pp. e1298-e1306.
@article{01d2248128014e5c99a53b6067493d26,
title = "Derivation of candidate clinical decision rules to identify infants at risk for central apnea",
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.",
author = "Paul Walsh and P{\'a}draig Cunningham and Sabrina Merchant and Nicholas Walker and Jacquelyn Heffner and Lucas Shanholtzer and Rothenberg, {Stephen J.}",
year = "2015",
month = "11",
day = "1",
doi = "10.1542/peds.2015-1825",
language = "English (US)",
volume = "136",
pages = "e1298--e1306",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "5",

}

TY - JOUR

T1 - Derivation of candidate clinical decision rules to identify infants at risk for central apnea

AU - Walsh, Paul

AU - Cunningham, Pádraig

AU - Merchant, Sabrina

AU - Walker, Nicholas

AU - Heffner, Jacquelyn

AU - Shanholtzer, Lucas

AU - Rothenberg, Stephen J.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84947292708&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84947292708&partnerID=8YFLogxK

U2 - 10.1542/peds.2015-1825

DO - 10.1542/peds.2015-1825

M3 - Article

AN - SCOPUS:84947292708

VL - 136

SP - e1298-e1306

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 5

ER -