Development and Validation of an Obstetric Comorbidity Risk Score for Clinical Use.
Development and Validation of an Obstetric Comorbidity Risk Score for Clinical Use.
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DOI：
10.1089/whr.2021.0046
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Escobar GJ
中科院分区：
文献类型：
--
作者：
Ruppel H;Liu VX;Kipnis P;Hedderson MM;Greenberg M;Forquer H;Lawson B;Escobar GJ
背景：合并症综合评分可以支持早期和系统地识别高危妇女的不良产科结局。本研究的目的是对产科合并症风险评分进行初步开发和验证，以便在电子健康记录（EHR）中自动实施，以供临床使用。方法：采用综合医疗保健系统Kaiser Permanente北加州2010年至2018年间分娩的妊娠回顾性队列的电子病历数据开发并验证了该评分。用于模型开发的结果包括分娩住院的不良产科事件（例如，子痫、出血、死亡）。候选预测因素包括产妇年龄、胎次、多胎妊娠，以及入院分娩前12个月内在医疗机构就诊时所做的任何产妇诊断。我们使用惩罚回归进行变量选择，使用逻辑回归拟合模型，并使用内部验证进行模型评估。我们还评估了妊娠18周时的产前模型性能。结果：发育队列（n = 227,405例妊娠）的转归率为3.8%，验证队列（n = 41,683例）的转归率为2.9%。在276个候选预测因子中，有37个被纳入最终模型。最终模型的验证c统计量为0.72（95%置信区间[CI] 0.70-0.73）。当在妊娠18周评估时，歧视略有减少（c统计量0.68 [95% CI 0.67-0.70]）。结论：产科合并症评分对不良产科结局有良好的区分。经过额外的适当验证后，该评分可以在电子病历中自动进行，以支持早期识别高风险妇女，并协助确保风险适当的孕产妇护理。
Background: A comorbidity summary score may support early and systematic identification of women at high risk for adverse obstetric outcomes. The objective of this study was to conduct the initial development and validation of an obstetrics comorbidity risk score for automated implementation in the electronic health record (EHR) for clinical use. Methods: The score was developed and validated using EHR data for a retrospective cohort of pregnancies with delivery between 2010 and 2018 at Kaiser Permanente Northern California, an integrated health care system. The outcome used for model development consisted of adverse obstetric events from delivery hospitalization (e.g., eclampsia, hemorrhage, death). Candidate predictors included maternal age, parity, multiple gestation, and any maternal diagnoses assigned in health care encounters in the 12 months before admission for delivery. We used penalized regression for variable selection, logistic regression to fit the model, and internal validation for model evaluation. We also evaluated prenatal model performance at 18 weeks of pregnancy. Results: The development cohort (n = 227,405 pregnancies) had an outcome rate of 3.8% and the validation cohort (n = 41,683) had an outcome rate of 2.9%. Of 276 candidate predictors, 37 were included in the final model. The final model had a validation c-statistic of 0.72 (95% confidence interval [CI] 0.70–0.73). When evaluated at 18 weeks of pregnancy, discrimination was modestly diminished (c-statistic 0.68 [95% CI 0.67–0.70]). Conclusions: The obstetric comorbidity score demonstrated good discrimination for adverse obstetric outcomes. After additional appropriate validation, the score can be automated in the EHR to support early identification of high-risk women and assist efforts to ensure risk-appropriate maternal care.
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影响因子：
3
作者：
Escobar, Gabriel J.;Gardner, Marla N.;Kipnis, Patricia
通讯作者：
Kipnis, Patricia
影响因子：
3
作者：
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影响因子：
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影响因子：
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作者：
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Schuit, Ewoud
DOI：
10.1093/jamia/ocz088
发表时间：
2019-12-01
影响因子：
6.4
作者：
Liu, Vincent X.;Bates, David W.;Shah, Nigam
通讯作者：
Shah, Nigam