• Ashwin N Udupa, Ahan A Majmudar, and Liem Tran.
• Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
• Paediatr Anaesth. 2024 May 1; 34 (5): 396404396-404.

ObjectiveTo systematically identify and synthesize the available evidence of the neurological airway respiratory cardiovascular other-surgical severity (NARCO-SS) score as compared to other pediatric specific perioperative scoring systems.DesignThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. All studies in all languages comparing NARCO-SS with pediatric perioperative scoring systems against outcomes were included. Records were screened and data were extracted by three independent reviewers into standardized pilot-tested extraction templates.Data SourcesElectronic searches were performed in MEDLINE, Embase, Scopus, and CINAHL (from inception to February 2023).Review MethodsThe references were uploaded to a validated software for systematic reviews (Rayyan) and screened against the inclusion criteria. Full text of included studies were reviewed and the available data were tabulated. We conducted Risk of Bias analysis on the included studies using the Prediction model Risk Of Bias ASsessment Tool (PROBAST).ResultsA meta-analysis could not be performed due to differences in outcome definitions across the included studies. Correlations between NARCO-SS scores, ASA-PS scores and the predefined outcomes of each study were presented as a narrative synthesis. The included studies were determined to have a high risk of bias using the PROBAST.ConclusionsThis review has identified a need for high-quality studies assessing NARCO-SS before recommendations for clinical practice can be made. Addressing its limitations and enhancing the NARCO-SS through targeted refinements of its individual descriptive categories could potentially lead to improvement in its overall predictive accuracy and facilitate wider adoption into clinical practice.© 2024 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.

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