Vorhersagemodelle für das Risiko von postoperativer Übelkeit und Erbrechen – Eine qualitative Analyse aller verfügbaren Vorhersagemodelle für das Auftreten von Übelkeit und Erbrechen nach Narkosen (PONV)
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Philipps-Universität Marburg
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Abstract
The aim of this work is to assess which predicting models and scores for PONV possess the greatest validity and generalizability and should therefore be used in clinical practice or research. We examine prognostic models that deal with development and validation. In addition, publications describing the broad application and practical relevance of scoring systems were considered. These articles report, a higher patient satisfaction, a shorter stay in hospital or fewer unplanned admissions. In research, the models are used to establish cohort equality in clinical studies and offer the opportunity to compare patient groups. Out of this group, only the scores that were subject of at least two publications were considered for the examination. This applied to 62 publications. The studies included a total of 81834 patients and were based on eight scores.
In 2014 there were, 1384 corresponding publications on seven electronic medical databases detected. A literature update in April 2018 revealed 391 additional publications. After removing the duplicates, screening the abstracts and reading the full texts 85 scientific papers from both literature searches were chosen for the next step in the selection process. These studies were entered into a data mask for further data analysis.
All publications dealing with the same score were grouped together. To analyse each cluster, standardized quality criteria were established. The self-developed evaluation tool examined and awarded points for the following properties of each publication: the generalizability, represented by the size of the patient population. The practicability is reflected in the number of the risk factors in the model, the risk calculation and the end point of each score. In addition the predictive accuracy of the model based on discrimination and calibration was assessed. The internal or external validations of a score were evaluated. Furthermore, points were awarded for broad application in practice,if it could be shown that the use of the score had an advantage for the patient or for research. In addition, extra points for aspects that have not been considered so far were assigned to each score. The maximum number of points that can be achieved in this evaluation system is 60.
Based on the quality criteria, the simplified Apfelscore from 1999 achieved the best score with 44 points. The Score of Van den Bosch 2005a took the second place with 33 points.The simplified Koivuranta Score from 1997 and the Sinclair Score from 1999 were rated as equivalent with 32,5 points each. Regarding the children population the best Score was the Eberhart’s POVOC Score from 2004 with 31 points.
Finally, a survey regarding the standard operating protocols (SOP) for PONV was sent to several clinics. They revealed that for adults procedures, most of them use the simplified Apfelscore from 1999. Half of the centers recommend general PONV prophylaxis for adults. In the treatment of children, all available SOPs used the POVOC score from 2004. A general prophylaxis recommendation for children is provided by all clinics participating in the survey.
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Created: 2022Issued: 2024-05-15Updated: 2024-05-15
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
PONVPONV
DFG-subjects
PONV
DDC-Numbers
610
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Bohlender, Theresa Monika: Vorhersagemodelle für das Risiko von postoperativer Übelkeit und Erbrechen – Eine qualitative Analyse aller verfügbaren Vorhersagemodelle für das Auftreten von Übelkeit und Erbrechen nach Narkosen (PONV). : Philipps-Universität Marburg 2024-05-15. DOI: https://doi.org/10.17192/z2023.0024.