Development and validation of a new clinical decision support tool to optimize screening for retinopathy of prematurity
(2022) In British Journal of Ophthalmology 106(11). p.1573-1580- 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... (More)
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.
(Less)
- 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
LU
; Sunnqvist, Birgitta
; Tornqvist, Kristina
LU
; Wallin, Agneta
; Holmström, Gerd
; Albertsson-Wikland, Kerstin
; Nilsson, Staffan
and Hellström, Ann
(Less) - organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- in
- British Journal of Ophthalmology
- volume
- 106
- issue
- 11
- pages
- 1573 - 1580
- publisher
- BMJ Publishing Group
- external identifiers
-
- scopus:85105999860
- pmid:33980506
- ISSN
- 0007-1161
- DOI
- 10.1136/bjophthalmol-2020-318719
- language
- English
- LU publication?
- yes
- id
- 0bfb7fad-ec45-4acb-8c87-78b6983409d7
- date added to LUP
- 2021-06-10 11:53:28
- date last changed
- 2024-06-01 11:40:58
@article{0bfb7fad-ec45-4acb-8c87-78b6983409d7,
abstract = {{<p>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.</p>}},
author = {{Pivodic, Aldina and Johansson, Helena and Smith, Lois E.H. and Hård, Anna Lena and Löfqvist, Chatarina and Yoder, Bradley A. and Hartnett, M. Elizabeth and Wu, Carolyn and Bründer, Marie Christine and Lagrèze, Wolf A. and Stahl, Andreas and Al-Hawasi, Abbas and Larsson, Eva and Lundgren, Pia and Gränse, Lotta and Sunnqvist, Birgitta and Tornqvist, Kristina and Wallin, Agneta and Holmström, Gerd and Albertsson-Wikland, Kerstin and Nilsson, Staffan and Hellström, Ann}},
issn = {{0007-1161}},
language = {{eng}},
number = {{11}},
pages = {{1573--1580}},
publisher = {{BMJ Publishing Group}},
series = {{British Journal of Ophthalmology}},
title = {{Development and validation of a new clinical decision support tool to optimize screening for retinopathy of prematurity}},
url = {{http://dx.doi.org/10.1136/bjophthalmol-2020-318719}},
doi = {{10.1136/bjophthalmol-2020-318719}},
volume = {{106}},
year = {{2022}},
}