Journal Article

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

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

2022

Overview

Background/AimsPrematurely 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.MethodsData, 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.ResultsROP 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%.ConclusionsDIGIROP-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.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Babies / Birth Weight / Clinical decision making / clinical decision support tool / Clinical Medicine / Clinical Science / Decision Support Systems, Clinical / diagnostic tests/Investigation / Eye examinations / Gestational Age / Health economics / Humans / Infant / Infant, Newborn / Insulin-like growth factors / Klinisk medicin / Medical and Health Sciences / Medical diagnosis / Medicin och hälsovetenskap / Missing data / Neonatal Screening / neovascularisation / Neurosciences / Oftalmiatrik / Oftalmologi / Ophtalmology / Ophthalmology / optimized screening / Peptide Nucleic Acids / prediction model / preterm / retinopathy of prematurity / Retinopathy of Prematurity - diagnosis / Retrospective Studies / Risk Factors / ROP screening / Variables