A stillbirth calculator: Development and internal validation of a clinical prediction model to quantify stillbirth risk.
A stillbirth calculator: Development and internal validation of a clinical prediction model to quantify stillbirth risk.
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DOI：
10.1371/journal.pone.0173461
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Odibo AO
中科院分区：
文献类型：
--
作者：
Trudell AS;Tuuli MG;Colditz GA;Macones GA;Odibo AO
开发一种结合孕产妇风险因素的死产临床预测工具，为识别哪些女性能从预防死产的产前检测中获益最多提供基于证据的方法。回顾性队列研究美国中西部第四纪转诊中心 1999 年至 2009 年接受中期妊娠解剖学调查的单胎妊娠。随访不完整的妊娠被排除在外。从文献和单变量分析中确定了候选预测因子。使用向后逐步逻辑回归以及模型辨别、校准和临床表现的统计比较来生成预测死产的最终模型。使用 bootstrapping 进行 1,000 次重复进行内部验证。开发了死产风险计算器和死产风险评分，用于预测 32 周或超过 32 周的死产，排除胎儿异常和非整倍体。确定了统计和临床切点，并使用综合辨别改进对工具进行了比较。 64,173 名产前死产妇女符合纳入标准。最终的死产风险计算器和评分包括母亲年龄、黑人种族、未生育、体重指数、吸烟、慢性高血压和孕前糖尿病。死产计算器和简单风险评分显示出适度的歧视，但具有临床显着的性能，工具之间的总体性能没有差异[(AUC 0.66 95% CI 0.60–0.72)和(AUC 0.64 95% CI 0.58–0.70)，(p = 0.25)]。死产风险评分纳入了产前护理期间容易确定的孕产妇风险因素，以确定单个妇女的死产风险，并为启动产前检测以预测和预防死产提供循证方法。
To generate a clinical prediction tool for stillbirth that combines maternal risk factors to provide an evidence based approach for the identification of women who will benefit most from antenatal testing for stillbirth prevention. Retrospective cohort study Midwestern United States quaternary referral center Singleton pregnancies undergoing second trimester anatomic survey from 1999–2009. Pregnancies with incomplete follow-up were excluded. Candidate predictors were identified from the literature and univariate analysis. Backward stepwise logistic regression with statistical comparison of model discrimination, calibration and clinical performance was used to generate final models for the prediction of stillbirth. Internal validation was performed using bootstrapping with 1,000 repetitions. A stillbirth risk calculator and stillbirth risk score were developed for the prediction of stillbirth at or beyond 32 weeks excluding fetal anomalies and aneuploidy. Statistical and clinical cut-points were identified and the tools compared using the Integrated Discrimination Improvement. Antepartum stillbirth 64,173 women met inclusion criteria. The final stillbirth risk calculator and score included maternal age, black race, nulliparity, body mass index, smoking, chronic hypertension and pre-gestational diabetes. The stillbirth calculator and simple risk score demonstrated modest discrimination but clinically significant performance with no difference in overall performance between the tools [(AUC 0.66 95% CI 0.60–0.72) and (AUC 0.64 95% CI 0.58–0.70), (p = 0.25)]. A stillbirth risk score was developed incorporating maternal risk factors easily ascertained during prenatal care to determine an individual woman’s risk for stillbirth and provide an evidenced based approach to the initiation of antenatal testing for the prediction and prevention of stillbirth.