Development and validation of a new clinical decision support tool to optimize screening for retinopathy of prematurity.

Aldina Pivodic, Helena Johansson, Lois E H Smith, Anna-Lena Hård, Chatarina Löfqvist, Bradley A Yoder, M Elizabeth Hartnett, Carolyn Wu, Marie-Christine Bründer, Wolf A Lagrèze, Andreas Stahl, Abbas Al-Hawasi, Eva Larsson, Pia Lundgren, Lotta Gränse, Birgitta Sunnqvist, Kristina Tornqvist, Agneta Wallin, Gerd Holmström, Kerstin Albertsson-Wikland, Staffan Nilsson, Ann Hellström

Journal: The British journal of ophthalmology 2022;106(11):1573-1580

PMID: 33980506

Free Full Text on HighWire View on PubMed

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.

Address: Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden [email protected].; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.; Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Learning and Leadership for Health Care Professionals, Institute of Health Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.; Department of Ophthalmology, John A Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.; Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany.; Department of Ophthalmology, Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.; Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden.; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Ophthalmology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.; Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden.; Länssjukhuset Ryhov, Jönköping, Sweden.; St. Erik Eye Hospital, Stockholm, Sweden.; Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden.; Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

DOI: 10.1136/bjophthalmol-2020-318719

Link outs

Free resources

Full Text Sources:

Other Literature Sources:

https://scite.ai/reports/33980506

Subscription / membership required

Full Text Sources:

http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linko...

MeSH Terms: Humans, Infant, Newborn, Infant, Retinopathy of Prematurity, Birth Weight, Decision Support Systems, Clinical, Peptide Nucleic Acids, Neonatal Screening, Risk Factors, Gestational Age, Retrospective Studies