Pramod S. Puligandla, Robert Baird, Eric D.

Skarsgard, Sherif Emil, Jean-Martin

Laberge,
Outcome prediction in gastroschisis – The gastroschisis prognostic score (GPS)
revisited,
Journal of Pediatric Surgery,
Volume 52, Issue 5,
2017,
Pages 718-721,
ISSN 0022-3468,
https://doi.org/10.1016/j.jpedsurg.2017.01.017.
(https://www.sciencedirect.com/science/article/pii/S0022346817300490)
Abstract: Purpose
The GPS enables risk stratification for gastroschisis and helps discriminate low
from high morbidity groups. The purpose of this study was to revalidate GPS's
characterization of a high morbidity group and to quantify relationships between
the GPS and outcomes.
Methods
With REB approval, complete survivor data from a national gastroschisis registry
was collected. GPS bowel injury scoring was revalidated excluding the initial
inception/validation cohorts (>2011). Length of stay (LOS), 1st enteral feed days
(dFPO), TPN days (dTPN), and aggregate complications (COMP) were compared between
low and high morbidity risk groups. Mathematical relationships between outcomes and
integer increases in GPS were explored using the entire cohort (2005–present).
Results
Median (range) LOS, dPO, and dTPN for the entire cohort (n=849) was 36 (26,62), 13
(9,18), and 27 (20,46) days, respectively. High-risk patients (GPS≥2; n=80)
experienced significantly worse outcomes than low risk patients (n=263). Each
integer increase in GPS was associated with increases in LOS and dTPN by 16.9 and
12.7days, respectively (p<0.01). COMP rate was also increased in the high-risk
cohort (46.3% vs. 22.8%; p<0.01).
Conclusion
The GPS effectively discriminates low from high morbidity risk groups. Within the
high risk group, integer increases in GPS produce quantitatively differentiated
outcomes which may guide initial counseling and resource allocation.
Level of evidence
IIb.
Keywords: Gastroschisis; Bowel injury score; Outcomes; Prediction; Validation; Risk
stratification