The following is a summary of “External validation and comparison of four prediction scores for severe maternal morbidity,” published in the August 2024 issue of Obstetrics and Gynecology by Binsted et al.
Severe maternal morbidity has been rising in the United States, underscoring the need for effective risk assessment tools. This study aimed to evaluate and compare the predictive validity of four distinct scoring systems for severe maternal morbidity. Researchers conducted a retrospective cohort analysis utilizing the Consortium on Safe Labor dataset, encompassing data from 2002 to 2008. Exclusion criteria were applied for individuals with incomplete risk factor information. Severe maternal morbidity was defined according to the Centers for Disease Control and Prevention criteria, excluding blood transfusions due to variability in clinical significance and ICD code specificity.
The four risk scores examined were the Assessment of Perinatal Excellence (APEx), the California Maternal Quality Care Collaborative (CMQCC), the Obstetric Comorbidity Index (OCI), and the Modified Obstetric Comorbidity Index (MOCI). Based on these scores, investigators computed the probability of severe maternal morbidity for each participant. They assessed the discriminative performance using the area under the receiver operating characteristic curve (AUC) and 95% CIs. Comparison of AUCs was performed via bootstrap resampling, and calibration plots were generated to evaluate goodness-of-fit.
The concordance probability method was used to determine optimal cutoff points for each scoring system. Out of 153,463 individuals, 1,115 (0.7%) experienced severe maternal morbidity. The CMQCC scoring system demonstrated superior predictive accuracy with an AUC of 0.78 (95% CI 0.77-0.80), outperforming the APEx (AUC 0.75, 95% CI 0.73-0.76), OCI (AUC 0.67, 95% CI 0.65-0.68), and MOCI (AUC 0.66, 95% CI 0.70-0.73) systems (P < 0.001). The APEx and OCI scores exhibited excellent calibration with P-values of 1.00 on the Hosmer–Lemeshow test, indicating a good fit. At optimal cutoff points, the APEx score exhibited the highest sensitivity among the scores at 71%.
These findings suggest that while the CMQCC and APEx scoring systems show strong discriminatory power, there remains a need for further refinement to enhance predictive accuracy for severe maternal morbidity.
Source: sciencedirect.com/science/article/abs/pii/S2589933324001976
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