Transport Risk Index of Physiologic Stability, version II (TRIPS-II): a simple and practical neonatal illness severity score

Abstract

Objective: Derive and validate a practical assessment of infant illness severity at admission to neonatal intensive care units (NICUs).

Study design: Prospective study involving 17,075 infants admitted to 15 NICUs in 2006 to 2008. Logistic regression was used to derive a prediction model for mortality comprising four empirically weighted items (temperature, blood pressure, respiratory status, response to noxious stimuli). This Transport Risk Index of Physiologic Stability, version II (TRIPS-II) was then validated for prediction of 7-day and total NICU mortality.

Results: TRIPS-II discriminated 7-day (receiver operating curve [ROC] area, 0.90) and total NICU mortality (ROC area, 0.87) from survival. Furthermore, there was a direct association between changes in TRIPS-II at 12 and 24 hours and mortality. There was good calibration across the full range of TRIPS-II scores and the gestational age at birth, and addition of TRIPS-II improved performance of prediction models that use gestational age and baseline population risk variables.

Conclusion: TRIPS-II is a validated benchmarking tool for assessing infant illness severity at admission and for up to 24 hours after.