“TOPS: a reliable and simplified tool for predicting mortality in transported neonates”

Background: Illness severity scores have been used as predictors of neonatal mortality to give prognostic information to parents about their baby,to identify high risk babies for prompt action (triage) and for standardized comparisons between neonatal units for quality assessment. Objective:To evaluatethe TOPS (Temperature,Oxygenation,Perfusion and blood Sugar) score predictive value for hospital death so as to institute an easy tool for assessing mortality index in transported neonates. Methods:A prospective study was conducted in a tertiary teaching hospital enrolling 500 transported neonates. TOPS scoring was done at admission (temperature by digital thermometer in axilla, saturation by pulse oximeter, capillary refill time in mid sternum region, blood sugar by reagentstrip) and babies were followed for outcome. Results: A mortality of 22.8% was observed. Prematurity and birth asphyxia were leading causes of mortality. Derangements in TOPS variables had significant correlation with neonatal mortality onunivariate odds ratio analysis. Hypothermia was commonly observed in transported neonates (39%).The sensitivity, specificity, positive and negative predictive values of derangements of two or more TOPS parameters in predicting mortality were 71.9%,80.8%,64.3% and 90.1% respectively. The score accuracy for mortality was confirmed (area under the ROC curve = 0.764). Conclusions: Besides being useful to predict hospital death, TOPS was a simple score that can be easily applied in neonatal units.Based on these results, we recommend TOPS score to be done routinely for all the babies at admission.