PREDICTIVE UTILITY OF COLDS SCORE IN DEVELOPMENT OF LARYNGOSPASM IN CHILDREN UNDERGOING ELECTIVE ADENOTONSILLECTOMY AT KENYATTA NATIONAL TEACHING ANDREFERRAL HOSPITAL, NAIROBI, KENYA

Abstract

Background: Children with upper respiratory tract infections, including
adenotonsillitis, are at a higher risk of perioperatively developing pediatric
respiratory adverse events. Frequent inflammation of adenoids and tonsils can lead to serious complications with growth and developmental consequences, warranting their surgical removal. The COLDS score, developed by Lee and August, is a validated clinical screening tool designed to assist in the pre-anesthetic evaluation of children with upper respiratory tract infections.
Objective: To investigate the utility of the COLDS score in predicting a
laryngospasm in children undergoing adenotonsillectomy at Kenyatta National Hospital (KNH), Nairobi, Kenya.
Methods: Eighty-four children aged 12 years and below were recruited in this single-center study, excluding those with uncorrected cardiac disease,
gastroesophageal reflux disease, and neuromuscular disorders. Laryngospasm occurrence was the dependent variable, while patient and anesthetic factors were independent variables analyzed using STATA version 15. Descriptive statistics were applied to age, sex, body mass index, and upper respiratory tract infection data. The COLDS score and laryngospasm occurrence generated a receiver operating characteristic curve, with a cut-off value of 16.5 used to determine sensitivity, specificity, positive predictive value, and negative predictive value.
Results: The incidence of laryngospasm was 4/84 (4.8%). The sensitivity of COLDS score above and including 16.5 was 75.0% (95% CI, 19.4% - 99.4%) with specificity of 65.0% (95% CI, 53.5% - 75.3%) and overall accuracy of 65.5% (95% CI, 54.3% - 75.5%). The Positive Predictive Value (PPV) was 9.68% (95% CI, 5.4% - 16.9%) and Negative Predicitve Value (NPV) 98.1% (95% CI, 90.4% - 99.7%).
Conclusion: The preoperative risk assessment for laryngospasm of children prone to recurrent upper respiratory tract infections (URTIs) scheduled for adenotonsillectomy remains subjective. Based on the findings of our study, while the COLDS score may not be adequate as an independent diagnostic tool, it provides predictive potential for ruling out laryngospasm