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Development and validation of a new clinical decision support tool to optimize screening for retinopathy of prematurity
Pivodic, Aldina Johansson, Helena Smith, Lois E. H. Hård, Anna-Lena Löfqvist, Chatarina Yoder, Bradley A. Hartnett, M. Elizabeth Wu, Carolyn Bründer, Marie-Christine Lagrèze, Wolf A.
Pivodic, Aldina
Johansson, Helena
Smith, Lois E. H.
Hård, Anna-Lena
Löfqvist, Chatarina
Yoder, Bradley A.
Hartnett, M. Elizabeth
Wu, Carolyn
Bründer, Marie-Christine
Lagrèze, Wolf A.
Author
Pivodic, Aldina
Johansson, Helena
Smith, Lois E. H.
Hård, Anna-Lena
Löfqvist, Chatarina
Yoder, Bradley A.
Hartnett, M. Elizabeth
Wu, Carolyn
Bründer, Marie-Christine
Lagrèze, Wolf A.
Stahl, Andreas
Al-Hawasi, Abbas
Larsson, Eva
Lundgren, Pia
Gränse, Lotta
Sunnqvist, Birgitta
Tornqvist, Kristina
Wallin, Agneta
Holmström, Gerd
Albertsson-Wikland, Kerstin
Nilsson, Staffan
Hellström, Ann
Johansson, Helena
Smith, Lois E. H.
Hård, Anna-Lena
Löfqvist, Chatarina
Yoder, Bradley A.
Hartnett, M. Elizabeth
Wu, Carolyn
Bründer, Marie-Christine
Lagrèze, Wolf A.
Stahl, Andreas
Al-Hawasi, Abbas
Larsson, Eva
Lundgren, Pia
Gränse, Lotta
Sunnqvist, Birgitta
Tornqvist, Kristina
Wallin, Agneta
Holmström, Gerd
Albertsson-Wikland, Kerstin
Nilsson, Staffan
Hellström, Ann
Abstract
Background/Aims Prematurely born infants undergo costly, stressful eye examinations to uncover the small fraction with retinopathy of prematurity (ROP) that needs treatment to prevent blindness. The aim was to develop a prediction tool (DIGIROP-Screen) with 100% sensitivity and high specificity to safely reduce screening of those infants not needing treatment. DIGIROP-Screen was compared with four other ROP models based on longitudinal weights.
Methods Data, including infants born at 24–30 weeks of gestational age (GA), for DIGIROP-Screen development (DevGroup, N=6991) originate from the Swedish National Registry for ROP. Three international cohorts comprised the external validation groups (ValGroups, N=1241). Multivariable logistic regressions, over postnatal ages (PNAs) 6–14 weeks, were validated. Predictors were birth characteristics, status and age at first diagnosed ROP and essential interactions.
Results ROP treatment was required in 287 (4.1%)/6991 infants in DevGroup and 49 (3.9%)/1241 in ValGroups. To allow 100% sensitivity in DevGroup, specificity at birth was 53.1% and cumulatively 60.5% at PNA 8 weeks. Applying the same cut-offs in ValGroups, specificities were similar (46.3% and 53.5%). One infant with severe malformations in ValGroups was incorrectly classified as not needing screening. For all other infants, at PNA 6–14 weeks, sensitivity was 100%. In other published models, sensitivity ranged from 88.5% to 100% and specificity ranged from 9.6% to 45.2%.
Conclusions DIGIROP-Screen, a clinical decision support tool using readily available birth and ROP screening data for infants born GA 24–30 weeks, in the European and North American populations tested can safely identify infants not needing ROP screening. DIGIROP-Screen had equal or higher sensitivity and specificity compared with other models. DIGIROP-Screen should be tested in any new cohort for validation and if not validated it can be modified using the same statistical approaches applied to a specific clinical setting.
Keywords
Date
2022
Type
Journal article
Journal
British Journal of Ophthalmology
Book
Volume
106
Issue
11
Page Range
1573-1580
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
CC BY-NC-ND 4.0
File Access
Open