Transport risk index of physiologic stability: A practical system for assessing infant transport care

Objectives: To develop and validate a practical, physiology-based system fo r assessment of infant transport care. Study design: Transport teams prospectively collected data, before and afte r transport, from 1723 infants at 8 neonatal intensive care units (NICUs) f rom 1996 to 1997. We used logistic regression to derive a prediction model for mortality within 7 days of NICU admission and develop the Transport Ris k Index of Physiologic Stability (TRIPS). We validated TRIPS for prediction of 7-day mortality, total NICU mortality (until discharge), and severe (gr eater than or equal to grade 3) intraventricular hemorrhage. Results: TRIPS comprises 4 empirically weighted items (temperature, blood p ressure, respiratory status, and response to noxious stimuli). TRIPS discri minated 7-day NICU mortality and total NICU mortality from survival with re ceiver operating characteristic areas of 0.83 and 0.76, respectively. There was good calibration across the full range of TRIPS scores and gestational age groups. Increase and decrease in TRIPS scores after transport were ass ociated with increased and decreased mortality, respectively. The receiver operating characteristic area for TRIPS prediction of severe intraventricul ar hemorrhage was 0.74. Addition of TRIPS improved performance of predictio n models in which gestational age and baseline population risk variables we re used. Conclusions: TRIPS is validated for infant transport assessment.