A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery
A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery
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DOI：
10.1016/j.ajog.2019.06.025
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发表时间：
2019-09-01
影响因子：
9.8
通讯作者：
Robinson, Julian N.
中科院分区：
文献类型：
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作者：
Easter, Sarah Rae;Bateman, Brian T.;Robinson, Julian N.
背景：产科合并症指数将孕产妇合并症的负担总结为一个数字，有望作为孕产妇风险评估工具。目的：本研究的目的是评估这种基于合并症的筛查工具的临床表现，以实时准确识别分娩和分娩中有严重产妇发病率风险的妇女。研究设计：2018年2月至7月在单一三级保健中心分娩的所有妊娠bb0 = 23周的患者均被纳入研究。患者的主要分娩和分娩护士评估患者的合并症，并计算患者的产科合并症指数。在每12小时换班时重新计算得分。一个多学科临床医生小组根据美国妇产科学会和母胎医学学会的共识定义确定患者是否经历了严重的孕产妇发病率，对患者的产科共病指数评分不知情。我们分析了产科合并症指数评分与严重产妇发病率之间的关系。结果：该研究纳入2828名妇女，其中1.73%出现严重孕产妇发病率（n=49）。研究队列中女性的产科合并症指数范围为0-15，产科合并症指数中位数为1（四分位数范围为0-3）。经历严重产妇发病率的妇女的产科共病指数得分中位数为5（四分位数范围，3-7），而没有严重产妇发病率的妇女的产科共病指数得分中位数为1（四分位数范围，0-3）（P= 9）。评分每增加1分，患者发生严重产妇发病的几率增加1.55（95%可信区间，1.42-1.70）。产科合并症指数评分的c统计量为0.83(95%可信区间为0.76-0.89)，表明存在强烈的歧视。结论：产科合并症指数可以在临床环境中前瞻性地识别有严重产妇发病率风险的妇女。产科合并症指数的一个特别优势在于它能够综合多种复合合并症，并突出与患者病情相关的累积风险。常规临床使用产科合并症指数有可能识别有风险的妇女，其病情需要加强监测和有针对性的护理，以防止不良的产妇结局。
BACKGROUND: The obstetric comorbidity index summarizes the burden of maternal comorbidities into a single number and holds promise as a maternal risk-assessment tool.OBJECTIVE: The aim of this study was to assess the clinical performance of this comorbidity-based screening tool to accurately identify women on labor and delivery who are at risk of severe maternal morbidity on labor and delivery in real time.STUDY DESIGN: All patients with pregnancies >= 23 weeks gestation presenting to labor and delivery at a single tertiary-care center from February through July 2018 were included in the study. The patient's primary labor and delivery nurse assessed patient comorbidities and calculated the patient's obstetric comorbidity index. The score was recalculated at each 12-hour shift change. A multidisciplinary panel of clinicians determined whether patients experienced severe maternal morbidity based on the American College of Obstetrics and Gynecology and Society for Maternal-Fetal Medicine consensus definition, blinded to the patient's obstetric comorbidity index score. We analyzed the association between the obstetric comorbidity index score and the occurrence of severe maternal morbidity.RESULTS: The study included 2828 women, of whom 1.73% experience severe maternal morbidity (n=49). The obstetric comorbidity index ranged from 0-15 for women in the study cohort, with a median obstetric comorbidity index of 1 (interquartile range, 0-3). The median obstetric comorbidity index score for women who experienced the severe maternal morbidity was 5 (interquartile range, 3-7) compared with a median of 1 (interquartile range, 0-3) for those without severe maternal morbidity (P= 9. For every 1-point increase in the score, patients experienced a 1.55 increase in odds of severe maternal morbidity (95% confidence interval, 1.42-1.70). The c-statistic for the obstetric comorbidity index score was 0.83 (95% confidence interval, 0.76-0.89), which indicated strong discrimination.CONCLUSION: The obstetric comorbidity index can prospectively identify women at risk of severe maternal morbidity in a clinical setting. A particular strength of the obstetric comorbidity index is its ability to integrate multiple compounding comorbidities and highlight the cumulative risk that is associated with the patients' conditions. Routine clinical use of the obstetric comorbidity index has the potential to identify at-risk women whose condition warrants increased surveillance and targeted care to prevent adverse maternal outcomes.