Abstract
BackgroundMedical management of critically ill equine neonates (foals) can be expensive and labor intensive. Predicting the odds of foal survival using clinical information could facilitate the decision-making process for owners and clinicians. Numerous prognostic indicators and mathematical models to predict outcome in foals have been published; however, a validated scoring method to predict survival in sick foals has not been reported. The goal of this study was to develop and validate a scoring system that can be used by clinicians to predict likelihood of survival of equine neonates based on clinical data obtained on admission.Methods and ResultsData from 339 hospitalized foals of less than four days of age admitted to three equine hospitals were included to develop the model. Thirty seven variables including historical information, physical examination and laboratory findings were analyzed by generalized boosted regression modeling (GBM) to determine which ones would be included in the survival score. Of these, six variables were retained in the final model. The weight for each variable was calculated using a generalized linear model and the probability of survival for each total score was determined. The highest (7) and the lowest (0) scores represented 97% and 3% probability of survival, respectively. Accuracy of this survival score was validated in a prospective study on data from 283 hospitalized foals from the same three hospitals. Sensitivity, specificity, positive and negative predictive values for the survival score in the prospective population were 96%, 71%, 91%, and 85%, respectively.ConclusionsThe survival score developed in our study was validated in a large number of foals with a wide range of diseases and can be easily implemented using data available in most equine hospitals. GBM was a useful tool to develop the survival score. Further evaluations of this scoring system in field conditions are needed.
Highlights
Equine neonates are highly susceptible to life-threatening conditions such as sepsis, hypoxic-ischemic encephalopathy, prematurity, and postpartum trauma that result in high mortality rates (20-60%) [1,2,3]
The survival score developed in our study was validated in a large number of foals with a wide range of diseases and can be implemented using data available in most equine hospitals
Poor prognosis for survival, reduced ability to perform at an expected level, and financial limitations are the main reasons for which sick foals are euthanized
Summary
Equine neonates are highly susceptible to life-threatening conditions such as sepsis, hypoxic-ischemic encephalopathy, prematurity, and postpartum trauma that result in high mortality rates (20-60%) [1,2,3]. Poor prognosis for survival, reduced ability to perform at an expected level, and financial limitations are the main reasons for which sick foals are euthanized In many instances this is a difficult decision for both clinicians and owners. In human ICU medicine, a number of scores are used to characterize severity of disease, degree of organ dysfunction, and to predict likelihood of mortality in adults and children [6]. Prognostic indicators and mathematical models to predict survival in hospitalized foals have been published [3,11,12,13,14,15,16]; to our knowledge, a validated scoring system to estimate survival in hospitalized newborn equine neonates has not been developed. The goal of this study was to develop and validate a scoring system that can be used by clinicians to predict likelihood of survival of equine neonates based on clinical data obtained on admission
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