Use of the CRIB (clinical risk index for babies) score in prediction of neonatal mortality and morbidity.

Courcy-Wheeler, R. H. B. de; Wolfe, Charles D.A.; Fitzgerald, Anthony P.; Spencer, Melanie; Goodman, J. D. S.; Gamsu, H R

doi:10.1136/fn.73.1.f32

Cited by 78 publications

(49 citation statements)

References 17 publications

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“…[4][5][6]8,10,13 Analysis of the predictive accuracy of birthweight, gestational age and CRIB score in relation to the risk of mortality, undergone by building a ROC curve, within the current study, determined that the CRIB scores greater than 4 present the best characteristics as a diagnostic test when compared to birthweight <1,005 g and gestational age <28 weeks. As in previous studies, the present investigation has demonstrated that the CRIB score is more accurate, with an area under the ROC curve of 0.88 (CI 95%: 0.84-0.92), differing significantly from birthweight, which has an area of 0.76 (CI 95%: 0.71-0.81).…”

Section: Discussionmentioning

confidence: 92%

“…11,12,16 Data from studies undertaken by the International Neonatal Network, in tertiary hospitals in the United Kingdom among newborns weighing less than 1500 g and/or less than 31 weeks gestational age, were analyzed and predictors for mortality were developed and proposed in 1993. 16 Since then, the CRIB score has been utilized in different neonatal units, 3,4,6,8,13 because it is a simple instrument which is sensitive and can be rapidly applied. It stresses parameters which reflect the physiological conditions of the newborn soon after birth and supercedes the disadvantages of birthweight specific and/or gestational age specific predictors of neonatal mortality.…”

Section: Introductionmentioning

confidence: 99%

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Escore CRIB, peso ao nascer e idade gestacional na avaliação do risco de mortalidade neonatal

et al. 2003

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ObjectiveTo evaluate the mortality rate of very low birth weight babies born at a Neonatal Intensive Care Unit (NICU) during a specified period of time according to variations in CRIB (Clinical Risk Index for Babies) score, birth weight and gestational age. MethodsFrom January 1997 to December 2000, the CRIB score was prospectively applied to all newborn infants admitted to the N ICU of an university hospital, of Londrina, Brazil, with birthweight under 1,500 g and/or less than 31 weeks' gestational age. The exclusion criteria were: death before 12 hours of life, presence of lethal congenital malformations and newborns who had been referred from other hospitals. ResultsTwo hundred and eighty-four infants met the inclusion criteria. Mean birth weight was 1,148±248 g (median =1,180), mean gestational age was 30.2±2.4 weeks (median =30.0) and mean CRIB score was 3.8±4.4 (median =2.0). The neonatal mortality rate was 23.2%, varying according to mean birthweight <750 g (72.7%), gestational age <29 weeks (57.1%) and CRIB score >10 (79.4%). Receiver Operating Characteristic (ROC) curves were composed for CRIB score, birth weight and gestational age to assess the ability of each to predict hospital mortality and the areas under the curve were respectively 0.88, 0.76 and 0.81. Sensitivity, specificity and predictive values were evaluated and all variables were considered predictors of mortality (p<0.0001). The optimal cut off point based on the ROC curve for the CRIB score was 4 with sensitivity 75.8%, specificity 86.7, positive predictive value 63.3% and negative predictive value 92.2%. ConclusionsIn this study infants with birthweight of less than 750 grams, less than 29 weeks gestational age and CRIB scores above 10 had higher mortality rates. However, a CRIB score higher than 4 proved to be a better predictor of mortality when compared to birthweight and gestational age.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Escore CRIB, peso ao nascer e idade gestacional na avaliação do risco de mortalidade neonatal

et al. 2003

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“…The NICHD score was developed in the United States (n ¼ 3603 infants 501 to 1500 g) 17 although with occasional poor performance and no better than birth weight alone. 18,19 In recent years, Pollack et al 20 has published risk models in a cohort of VLBW infants from the Washington, DC area. They found that these scores overpredicted mortality indicating a need for frequent recalibration.…”

Section: Discussionmentioning

confidence: 99%

A New Score for Predicting Neonatal Very Low Birth Weight Mortality Risk in the NEOCOSUR South American Network

et al. 2005

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in infants with birth weight 500 to 1500 g were employed. A testing sample and crossvalidation techniques were used to validate a statistical model for risk of in-hospital mortality. The new risk score was compared with two existing scores by using area under the receiver operating characteristic curve (AUC). RESULTS:The new NEOCOSUR score was highly predictive for in-hospital mortality (AUC ¼ 0.85) and performed better than the Clinical Risk Index for Babies (CRIB) and the NICHD risk models when used in the NEOCOSUR Network. The new score is also well calibrated F it had good predictive capability for in-hospital mortality at all levels of risk (HL test ¼ 11.9, p ¼ 0.85). The new score also performed well when used to predict in hospital neurological and respiratory complications. CONCLUSIONS:A new and relatively simple VLBW mortality risk score had a good prediction performance in a South American network population. This is an important tool for comparison purposes among NICUs. This score may prove to be a better model for application in developing countries.

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“…The Clinical Risk Index for Babies (CRIB) [9] is one of the most widely used scores [8,10], validated in a variety of studies [11,12,13,14,15,16,17]. However, it has been criticized for its inclusion of the applied fraction of inspired oxygen (FiO 2 ), which is adjusted by the physician.…”

Section: Introductionmentioning

confidence: 99%

Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants?

et al. 2015

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Background: Comparing outcomes at different neonatal intensive care units (NICUs) requires adjustment for intrinsic risk. The Clinical Risk Index for Babies (CRIB) is a widely used risk model, but it has been criticized for being affected by therapeutic decisions. The Prematurity Risk Evaluation Measure (PREM) is not supposed to be prone to treatment bias, but has not yet been validated. Objectives: We aimed to validate the PREM, compare its accuracy to that of the original and modified versions of the CRIB and CRIB-II, and examine the congruence of risk categorization. Methods: Very-low-birth-weight (VLBW) infants with a gestational age (GA) <33 weeks, who were admitted to NICUs in Baden-Württemberg from 2003 to 2008, were identified from the German neonatal quality assurance program. CRIB, CRIB-II and PREM scores were calculated and modified. Omitting variables that directly reflected therapeutic decisions [the applied fraction of inspired oxygen (FiO₂)] or that may have been prone to early-treatment bias (base excess and temperature), non-NICU-therapy-influenced scores were obtained. Score performance was assessed by the area under their ROC curve (AUC). Results: The CRIB showed the largest AUC (0.89), which dropped significantly (to 0.85) after omitting the FiO₂. The PREM birth condition model, PREM(bcm) (AUC 0.86), and the PREM birth model, PREM(bm) (AUC 0.82), also demonstrated good discrimination. PREM(bm) was superior to other non-therapy-affected scores and to GA, particularly in infants with <750 g birth weight. Congruence of risk categorization was low, especially among higher-risk cases. Conclusions: The CRIB score had the largest AUC, resulting from its inclusion of FiO₂. PREM(bm), as the most accurate score among those unaffected by early treatment, seems to be a good alternative for strict risk adjustment in NICU auditing. It could be useful to combine scores.

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Use of the CRIB (clinical risk index for babies) score in prediction of neonatal mortality and morbidity.

Cited by 78 publications

References 17 publications

Escore CRIB, peso ao nascer e idade gestacional na avaliação do risco de mortalidade neonatal

Escore CRIB, peso ao nascer e idade gestacional na avaliação do risco de mortalidade neonatal

A New Score for Predicting Neonatal Very Low Birth Weight Mortality Risk in the NEOCOSUR South American Network

Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants?

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