Palineo score: development of a score to identify the palliative care needs of neonatal patients admitted to the neonatal intensive care unit

TL;DR

This study developed the Palineo score to identify palliative care needs in neonatal ICU patients, showing strong agreement and accuracy in classifications.

Contribution

The novel contribution is the creation and validation of the Palineo score for neonatal palliative care needs.

Findings

The Palineo score demonstrated strong inter-rater agreement (k = 0.85) across evaluations.

The score showed exceptional accuracy in distinguishing palliative care classifications (p < 0.001).

Discrepant values were noted, suggesting the need for further validation in larger samples.

Abstract

To develop a score (Palineo score) to identify the palliative care needs of newborn patients admitted to a Brazilian neonatal intensive care unit of a tertiary maternity hospital that serves as a reference center for high-risk pregnancies, ensuring timely follow-up by a specialist.

Patients were assessed by three specialists using a questionnaire that included the same clinical elements as those used for the Palineo score but did not assign scores to the criteria. The score was determined by the consensus reached by the specialists. A score was subsequently assigned to each component of the Palineo score, allowing for comparisons between the specialists’ assessments and the Palineo score. All the information was retrospectively obtained from the electronic medical records. Data were collected and evaluated on the third and seventh days of life and then weekly until discharge from the neonatal intensive care unit, transfer to another service, or death. The Palineo score was applied to each patient to establish discriminatory cutoff points for the classifications initially assigned by the specialists.

The score showed agreement across the evaluations (k = 0.85). The discriminant values of the Palineo score between patients classified as palliative intent and associated palliative care revealed exceptional accuracy for both the first application of the score (p < 0.001) and the final application (p < 0.001). The discriminant values between patients categorized as associated palliative care and those categorized as specialized palliative care showed exceptional accuracy for the first application (p = 0.005) and final application (p < 0.001) of the score.

Despite exceptional accuracy, discrepant values should be considered with caution. This study should be replicated in a larger sample.

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