Development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients: the VPOP score

Summary Background Few data are available in the literature on risk factors for postoperative vomiting ( POV ) in children. Objective The aim of the study was to establish independent risk factors for POV and to construct a pediatric specific risk score to predict POV in children. Methods Characteristics of 2392 children operated under general anesthesia were recorded. The dataset was randomly split into an evaluation set ( n  = 1761), analyzed with a multivariate analysis including logistic regression and backward stepwise procedure, and a validation set ( n  = 450), used to confirm the accuracy of prediction using the area under the receiver operating characteristic curve ( ROC AUC ), to optimize sensitivity and specificity. Results The overall incidence of POV was 24.1%. Five independent risk factors were identified: stratified age (>3 and <6 or >13 years: adjusted OR 2.46 [95% CI 1.75–3.45]; ≥6 and ≤13 years: a OR 3.09 [95% CI 2.23–4.29]), duration of anesthesia (a OR 1.44 [95% IC 1.06–1.96]), surgery at risk (a OR 2.13 [95% IC 1.49–3.06]), predisposition to POV (a OR 1.81 [95% CI 1.43–2.31]), and multiple opioids doses (a OR 2.76 [95% CI 2.06–3.70], P  < 0.001). A simplified score was created, ranging from 0 to 6 points. Respective incidences of POV were 5%, 6%, 13%, 21%, 36%, 48%, and 52% when the risk score ranged from 0 to 6. The model yielded a ROC AUC of 0.73 [95% CI 0.67–0.78] when applied to the validation dataset. Conclusions Independent risk factors for POV were identified and used to create a new score to predict which children are at high risk of POV .