Risk Assessment of Perioperative Respiratory Adverse Events and Validation of the COLDS Score in Children with Upper Respiratory Tract Infection

Abstract

Background and objectives: Children are at greater risk of upper respiratory tract infection (URTI), which can pose a higher risk of perioperative respiratory adverse events (PRAEs), than adults. The purpose of this study was to validate the COLDS score as a pre-anesthetic risk assessment tool for predicting the possibility of PRAEs. Materials and methods: Children aged under 18 years and undergoing elective surgery were retrospectively included. Logistic regression analysis and the area under the receiver-operating characteristic (ROC) curve (AUC) were used to estimate the ability of the COLDS score to predict PRAEs. Propensity-matched comparison was evaluated using the cut-off value from the ROC curve. Results: Among the 6252 children, 158 children had a recent URTI and 34 cases of PRAEs were reported. Age, current symptoms, and COLDS score were found to be significant variables in predicting PRAEs. From the ROC curve, values of 0.652 (p = 0.007) for AUC and 12.5 for the cut-off value of the COLDS score were calculated. Propensity-matched comparison revealed that each and every component of COLDS contributed to the higher COLDS score group. In addition to higher COLDS score, younger age and current URTI symptoms were found to be significant risk factors for PRAEs. Conclusions: This study validated the predictive power of COLDS score as a risk assessment tool for children with URTI undergoing elective surgery under general anesthesia.

Keywords: COLDS score; pediatric anesthesia; perioperative respiratory adverse events; pre-anesthetic risk assessment; upper respiratory tract infection.

Figure 1

Graphs depicting the occurrence of perioperative respiratory adverse events (PRAEs) according to COLDS score. (a) Number of patients who suffered PRAEs according to COLDS score. (b) Description of each COLDS category in the patients with PRAEs. The five components of the COLDS score did not contribute equally to the total score. Total COLDS scores were contributed in the order of “D”, “O”, and the others. * p < 0.05 compared to “C”, “L”, or “S”, † p < 0.05 compared to “O”.

Figure 2

The receiver operating characteristic curve (ROC) was drawn to assess the ability of the COLDS score to predict perioperative respiratory adverse events (PRAEs).