Evaluation of the foal survival score in a Danish-Swedish population of neonatal foals upon hospital admission

Background It is highly desirable to assess the probability of survival in sick neonatal foals upon admission. The foal survival score (FSS) is a published scoring system used to estimate the probability of survival in hospitalized neonatal foals Five-hundred ninety hospitalized neonatal foals <= 14 days of age. Methods Retrospective Danish-Swedish multicenter study that included details of signalment, history, clinical examination, laboratory results, necropsy findings, and outcome. Scores and score variables were compared between survivors and nonsurvivors using logistic regression. The optimal cutoff and its test parameters were calculated using a receiver operator characteristic curve. Results Prematurity, cold extremities, >= 2 infectious or inflammatory sites, blood glucose concentration, and total white blood cell counts were significantly associated with nonsurvival (P <= .02). The optimal cutoff to predict survival was >= 6, resulting in sensitivity 78%, specificity 58%, 92% positive predictive value, and 31% negative predictive value. The test performed equally well in foals <4 days old compared to those 4-14 days old. Conclusions and Clinical Importance Using the suggested optimal cutoff of >= 6, the FSS performed moderately well and may aid in early determination of prognosis for survival. However, the FSS did perform differently in another population and therefore should be assessed under local conditions so that its diagnostic potential is not overestimated.