Validation of the Children's Hospital of Philadelphia Retinopathy of Prematurity (CHOP ROP) Model
Validation of the Children's Hospital of Philadelphia Retinopathy of Prematurity (CHOP ROP) Model
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DOI：
10.1001/jamaophthalmol.2017.2295
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发表时间：
2017-08-01
影响因子：
8.1
通讯作者：
Tomlinson, Lauren A.
中科院分区：
文献类型：
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作者：
Binenbaum, Gil;Ying, Gui-shuang;Tomlinson, Lauren A.
费城儿童医院早产儿视网膜病变（CHOP ROP）模型使用出生体重（BW）、出生时胎龄（GA）和体重增加率来预测重度早产儿视网膜病变（ROP）的风险。在一项模型开发研究中，它预测了所有需要治疗的婴儿，同时大大减少了与当前筛查指南相比的检查次数。目的：在一个大到足以获得模型对需要治疗的ROP的敏感性的精确估计的多中心队列中验证CHOP ROP模型。这项研究是对早产儿出生后生长和视网膜病变（G-ROP）研究数据的二次分析。研究背景为2006年1月1日至2012年6月30日期间美国和加拿大的30家医院。分析日期为2015年9月28日至10月5日。参与者是早产儿在ROP的风险与已知的ROPoutcome.Main结局和措施视网膜病变的早产儿1型ROP的早期治疗的敏感性和潜在的减少需要检查的婴儿的数量。在主要分析中，每周应用CHOP ROP模型预测ROP的风险。如果风险高于临界点水平（高风险），则需要进行检查，而低风险婴儿则不接受检查。在二次分析中，低风险的婴儿接受较少的检查，而不是没有examinations.RESULTS参与者包括7483早产儿ROP的风险与已知的ROP的结果。他们的中位体重为1070 g（范围310-3000 g），中位GA为28周（范围22-35周）。其中，3575例（47.8%）为女性，其人种/种族为3615例白色（48.3%）、2310例黑人（30.9%）、233例亚洲人（3.1%）、93例太平洋岛民（1.2%）和40例美洲印第安人/阿拉斯加原住民（0.5%）。最初的CHOP ROP模型正确预测了459例发生1型ROP的婴儿中的452例（灵敏度，98.5%; 95%CI，96.9%-99.3%），如果仅高危婴儿接受检查，则需要检查的婴儿数量减少了34.3%。降低临界点以捕获所有1型ROP病例（灵敏度，100%; 95% CI，99.2%-100%），导致仅6.8%的婴儿不需要检查。然而，如果低风险婴儿在月经后37周时进行检查，并且仅在检查时存在ROP时进行随访，则所有1型ROP病例都将被捕获，27周以上GA患儿的检查次数减少28.4%。结论与相关性CHOP ROP模型的诊断率较高，但并非100%灵敏度，可以更好地用于减少检查频率。该模型可以可靠地用于指导修改后的ROP筛查时间表并减少执行的检查数量。
IMPORTANCE The Children's Hospital of Philadelphia Retinopathy of Prematurity (CHOP ROP) model uses birth weight (BW), gestational age at birth (GA), and weight gain rate to predict the risk of severe retinopathy of prematurity (ROP). In a model development study, it predicted all infants requiring treatment, while greatly reducing the number of examinations compared with current screening guidelines.OBJECTIVE To validate the CHOP ROP model in a multicenter cohort that is large enough to obtain a precise estimate of the model's sensitivity for treatment-requiring ROP.DESIGN, SETTING, AND PARTICIPANTS This investigation was a secondary analysis of data from the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study. The setting was 30 hospitals in the United States and Canada between January 1, 2006, and June 30, 2012. The dates of analysis were September 28 to October 5, 2015. Participants were premature infants at risk for ROP with a known ROP outcome.MAIN OUTCOMES AND MEASURES Sensitivity for Early Treatment of Retinopathy of Prematurity type 1 ROP and potential reduction in the number of infants requiring examinations. In the primary analysis, the CHOP ROP model was applied weekly to predict the risk of ROP. If the risk was above a cut-point level (high risk), examinations were indicated, while low-risk infants received no examinations. In a secondary analysis, low-risk infants received fewer examinations rather than no examinations.RESULTS Participants included 7483 premature infants at risk for ROP with a known ROP outcome. Their median BW was 1070 g (range, 310-3000 g), and their median GA was 28 weeks (range, 22-35 weeks). Among them, 3575 (47.8%) were female, and their race/ethnicity was 3615 white (48.3%), 2310 black (30.9%), 233 Asian (3.1%), 93 Pacific Islander (1.2%), and 40 American Indian/Alaskan native (0.5%). The original CHOP ROP model correctly predicted 452 of 459 infants who developed type 1 ROP (sensitivity, 98.5%; 95% CI, 96.9%-99.3%), reducing the number of infants requiring examinations by 34.3% if only high-risk infants received examinations. Lowering the cut point to capture all type 1 ROP cases (sensitivity, 100%; 95% CI, 99.2%-100%) resulted in only 6.8% of infants not requiring examinations. However, if low-risk infants were examined at 37 weeks' postmenstrual age and followed up only if ROP was present at that examination, all type 1 ROP cases would be captured, and the number of examinations performed among infants with GA exceeding 27 weeks would be reduced by 28.4%.CONCLUSION AND RELEVANCE The CHOP ROP model demonstrated high but not 100% sensitivity and may be better used to reduce examination frequency. The model might be used reliably to guide a modified ROP screening schedule and decrease the number of examinations performed.