Refining the Apgar score cut-off point for newborns at risk
Aim: To evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality rate. Methods: The records of all singleton live births without severe congenital malformations and length of gestation >25 wk (n= 976635) w...
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Published in | Acta Paediatrica Vol. 93; no. 1; pp. 53 - 59 |
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Main Authors | , |
Format | Journal Article |
Language | English |
Published |
Oxford, UK
Blackwell Publishing Ltd
01.01.2004
Blackwell |
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Abstract | Aim: To evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality rate. Methods: The records of all singleton live births without severe congenital malformations and length of gestation >25 wk (n= 976635) were collected from the Swedish Medical Birth Registry, 1990 to 1998. Receiver operating characteristic (ROC) analysis was utilized. Results: Both the 1‐min and the 5‐min Apgar scores were shown to be good discriminators for early mortality, with the area under the ROC curve >0.85. For babies at risk of early death, the selected cut‐off values for the 1‐min Apgar score was >8 for preterm (true‐positive (TP) rate: 83.9%; false‐positive (FP) rate: 17.7%) and term babies (TP rate: 69.4%; FP rate: 6.7%). At 5 min, the analysis revealed that newborns with an Apgar score >9 were at risk for early death (preterm babies: TP rate: 79.8%; FP rate: 13.3%; term babies: TP rate: 73.8%; FP rate: 3.4%).
Conclusions: Our analysis did not support the common practice in the clinic or in research of grouping infants at risk in Apgar score groups, i.e. a score below 4 or a score below 7. However, the data presented here allow the clinicians and researchers to identify and define a suitable cutoff point in relation to the quality of neonatal care and resources available, rather than adhering to a historical cut‐off value that has not been studied in depth. |
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AbstractList | To evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality rate.
The records of all singleton live births without severe congenital malformations and length of gestation >25 wk (n = 976635) were collected from the Swedish Medical Birth Registry, 1990 to 1998. Receiver operating characteristic (ROC) analysis was utilized.
Both the 1-min and the 5-min Apgar scores were shown to be good discriminators for early mortality, with the area under the ROC curve >0.85. For babies at risk of early death, the selected cut-off values for the 1-min Apgar score was <8 for preterm (true-positive (TP) rate: 83.9%; false-positive (FP) rate: 17.7%) and term babies (TP rate: 69.4%; FP rate: 6.7%). At 5 min, the analysis revealed that newborns with an Apgar score <9 were at risk for early death (preterm babies: TP rate: 79.8%; FP rate: 13.3%; term babies: TP rate: 73.8%; FP rate: 3.4%).
Our analysis did not support the common practice in the clinic or in research of grouping infants at risk in Apgar score groups, i.e. a score below 4 or a score below 7. However, the data presented here allow the clinicians and researchers to identify and define a suitable cut-off point in relation to the quality of neonatal care and resources available, rather than adhering to a historical cut-off value that has not been studied in depth. AIMTo evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality rate.METHODSThe records of all singleton live births without severe congenital malformations and length of gestation >25 wk (n = 976635) were collected from the Swedish Medical Birth Registry, 1990 to 1998. Receiver operating characteristic (ROC) analysis was utilized.RESULTSBoth the 1-min and the 5-min Apgar scores were shown to be good discriminators for early mortality, with the area under the ROC curve >0.85. For babies at risk of early death, the selected cut-off values for the 1-min Apgar score was <8 for preterm (true-positive (TP) rate: 83.9%; false-positive (FP) rate: 17.7%) and term babies (TP rate: 69.4%; FP rate: 6.7%). At 5 min, the analysis revealed that newborns with an Apgar score <9 were at risk for early death (preterm babies: TP rate: 79.8%; FP rate: 13.3%; term babies: TP rate: 73.8%; FP rate: 3.4%).CONCLUSIONSOur analysis did not support the common practice in the clinic or in research of grouping infants at risk in Apgar score groups, i.e. a score below 4 or a score below 7. However, the data presented here allow the clinicians and researchers to identify and define a suitable cut-off point in relation to the quality of neonatal care and resources available, rather than adhering to a historical cut-off value that has not been studied in depth. Aim : To evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality rate. Methods : The records of all singleton live births without severe congenital malformations and length of gestation >25 wk ( n = 976635) were collected from the Swedish Medical Birth Registry, 1990 to 1998. Receiver operating characteristic (ROC) analysis was utilized. Results : Both the 1‐min and the 5‐min Apgar scores were shown to be good discriminators for early mortality, with the area under the ROC curve >0.85. For babies at risk of early death, the selected cut‐off values for the 1‐min Apgar score was >8 for preterm (true‐positive (TP) rate: 83.9%; false‐positive (FP) rate: 17.7%) and term babies (TP rate: 69.4%; FP rate: 6.7%). At 5 min, the analysis revealed that newborns with an Apgar score >9 were at risk for early death (preterm babies: TP rate: 79.8%; FP rate: 13.3%; term babies: TP rate: 73.8%; FP rate: 3.4%). Conclusions : Our analysis did not support the common practice in the clinic or in research of grouping infants at risk in Apgar score groups, i.e. a score below 4 or a score below 7. However, the data presented here allow the clinicians and researchers to identify and define a suitable cutoff point in relation to the quality of neonatal care and resources available, rather than adhering to a historical cut‐off value that has not been studied in depth. Aim: To evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality rate. Methods: The records of all singleton live births without severe congenital malformations and length of gestation >25 wk (n= 976635) were collected from the Swedish Medical Birth Registry, 1990 to 1998. Receiver operating characteristic (ROC) analysis was utilized. Results: Both the 1‐min and the 5‐min Apgar scores were shown to be good discriminators for early mortality, with the area under the ROC curve >0.85. For babies at risk of early death, the selected cut‐off values for the 1‐min Apgar score was >8 for preterm (true‐positive (TP) rate: 83.9%; false‐positive (FP) rate: 17.7%) and term babies (TP rate: 69.4%; FP rate: 6.7%). At 5 min, the analysis revealed that newborns with an Apgar score >9 were at risk for early death (preterm babies: TP rate: 79.8%; FP rate: 13.3%; term babies: TP rate: 73.8%; FP rate: 3.4%). Conclusions: Our analysis did not support the common practice in the clinic or in research of grouping infants at risk in Apgar score groups, i.e. a score below 4 or a score below 7. However, the data presented here allow the clinicians and researchers to identify and define a suitable cutoff point in relation to the quality of neonatal care and resources available, rather than adhering to a historical cut‐off value that has not been studied in depth. |
Author | Karlberg, J Chong, DSY |
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Cites_doi | 10.1177/140349489001800209 10.1067/mpd.2001.109608 10.1213/00000539-195301000-00041 10.1111/j.1651-2227.1960.tb05962.x 10.1126/science.171.3977.1217 10.1148/radiology.143.1.7063747 10.1056/NEJM200102153440701 10.1016/S0022-3476(58)80058-X 10.1542/peds.101.1.77 10.1016/S0029-7844(98)00326-3 |
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Keywords | Human Pediatrics Neonatal birth register Mortality Curve Apgar score Birth Epidemiology Newborn Register Receiver operating characteristic curves ROC curve Signal detection |
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Snippet | Aim: To evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality... To evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality rate.... Aim : To evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality... AIMTo evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality... |
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SubjectTerms | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Apgar Score Biological and medical sciences birth register Emergency and intensive care: neonates and children. Prematurity. Sudden death General aspects Humans Infant Mortality Infant, Newborn Intensive care medicine Medical Records Medical sciences mortality neonatal Predictive Value of Tests Registries Risk ROC Curve Sweden |
Title | Refining the Apgar score cut-off point for newborns at risk |
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