A contemporary prediction rule for esophageal atresia (EA) and tracheo-esophageal fistula (TEF).

Background/purpose: Existing prediction models for tracheo-esophageal fistula (TEF) and esophageal atresia (EA) are derived from small single-institution populations treated over long periods. A prediction rule developed in a contemporary, multicenter cohort is important for counseling, tailoring therapy, and benchmarking outcomes.

Methods: Data were obtained from the 2003, 2006, and 2009 editions of the HCUP Kids' Inpatient Database. Subjects included patients with admission age
Results: An integer-based prediction model was created, identifying patients at high, intermediate, and low risk of death with very good discrimination (c=0.723) and calibration. It is particularly effective at identifying the small population at highest risk of death. The model can be summarized as follows with patients first assigned a score for associated abnormalities: chromosomal abnormality=6 points, major cardiac anomaly=3 points, renal anomaly=2 points, and weight less than 1500g=9 points. Point score cut-offs were 0-6 points low risk, 7-14 intermediate risk, and 15-20 high risk.

Conclusions: This model compares well with existing prediction models and more effectively discriminates the highest risk patients who may require tailored therapy. The Spitz model is also validated.