Aim: To evaluate role of TOPS (a simplified assessment of neonatal acute physiology) in predicting mortality in transported neonates and to compare it with SNAP II.
Design: Prospective study.
Setting: Referral Neonatal Unit of a teaching hospital.
Subjects: 175 neonates > 1000 g admitted to referral nursery.
Methods: Temperature, oxygenation, capillary refill time (proxy for perfusion) and blood sugar (given the acronym of TOPS) were recorded at admission. SNAP II was also recorded for first 12 hours following admission.
Results: All the TOPS variables had significant correlation with fatality on univariate analysis. Fatality was 100% when all the four TOPS variables were deranged. The sensitivity, specificity, positive and negative predictive values of derangements of two or more TOPS parameters in predicting mortality were 81.6%, 77.39%, 65.3% and 89%, respectively All the variables of SNAP II significantly correlated with mortality. A cut-off score of 24 was derived from the ROC curve. The sensitivity, specificity, positive and negative predictive values of SNAP II score > 24 in predicting mortality were 78.3%, 86.1%, 74.6% and 88.4%, respectively. The area under ROC curve for derangements of 2 or more TOPS parameters was 0.89 while that for SNAP II was 0.88. Both models were well calibrated (p value for Hosmer Lemeshow goodness of fit for TOPS was 0.75 while that for SNAP II was 0.80). The total correct classification rate for TOPS was 81.7%, while that for SNAP II was 83.4%.
Conclusion: TOPS has an equally good prediction for mortality as SNAP II and can be used as a simple and useful method of assessment of risk of fatality that can be assessed immediately, at admission.