Validation of the COLDS Score for Perioperative Respiratory Adverse Event Risk Assessment in the Pediatric Patient Presenting with Upper Respiratory Tract Infection

Introduction: The decision to proceed with anesthesia and surgery has been controversial in pediatric patients with upper respiratory tract infection (URI), with no set algorithm to determine whether to proceed or delay surgery and anesthesia. The COLDS score was proposed by Lee and August as a potential risk stratification scheme, but no validation has been done on this scale. Here we evaluated the utility of the COLDS score in predicting perioperative respiratory adverse events (PRAE).Methods: COLDS scores, incidence of perioperative respiratory adverse events, surgical procedure type and age were collected for 536 patients who met inclusion criteria. AUCs were assessed for total COLDS score and individual COLDS score categories. Multivariate regression was also performed to further optimize the scale. To quantify the decrease in risk associated with cancellation of a case, the immutable risk factors were assessed separately from URI status in the COLDS score and incidence of perioperative respiratory complications tabulated.Results: AUC for the total COLDS score was 0.69. When split into individual component scores, the AUC ranged from 0.55-0.63, while AUC for the refitted scoring system was 0.71. The AUC for the scoring system was higher in younger children (AUC = 0.70-0.71) than for children aged 4-6 (AUC=0.66). The rate of perioperative respiratory adverse events increased with increasing “LDS” score (immutable risk factors), patients who had upper respiratory tract infections on the day of their procedure had higher rates of perioperative respiratory complications than those who did not. There was also a non-significant trend towards an inverse association between LDS score and upper respiratory tract infection status. Conclusions: The COLDS score has the potential to be a valuable risk assessment tool for prediction of perioperative respiratory complications. It appears to have a better predictive value in a younger population. Refitting the COLDS scoring did not appear to greatly improve AUC