Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA.
Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA.
Am J Obstet Gynecol MFM. 2024 Oct;6(10):101471. doi: 10.1016/j.ajogmf.2024.101471. Epub 2024 Aug 22.
Severe maternal morbidity (SMM) is increasing in the United States. Several tools and scores exist to stratify an individual's risk of SMM.
We sought to examine and compare the validity of four scoring systems for predicting SMM.
This was a retrospective cohort study of all individuals in the Consortium on Safe Labor dataset, which was conducted from 2002 to 2008. Individuals were excluded if they had missing information on risk factors. SMM was defined based on the Centers for Disease Control and Prevention excluding blood transfusion. Blood transfusion was excluded due to concerns regarding the specificity of International Classification of Diseases codes for this indicator and its variable clinical significance. Risk scores were calculated for each participant using the Assessment of Perinatal Excellence (APEX), California Maternal Quality Care Collaborative (CMQCC), Obstetric Comorbidity Index (OB-CMI), and modified OB-CMI. We calculated the probability of SMM according to the risk scores. The discriminative performance of the prediction score was examined by the areas under receiver operating characteristic curves and their 95% confidence intervals (95% CI). The area under the curve for each score was compared using the bootstrap resampling. Calibration plots were developed for each score to examine the goodness-of-fit. The concordance probability method was used to define an optimal cutoff point for the best-performing score.
Of 153, 463 individuals, 1115 (0.7%) had SMM. The CMQCC scoring system had a significantly higher area under the curve (95% CI) (0.78 [0.77-0.80]) compared to the APEX scoring system, OB-CMI, and modified OB-CMI scoring systems (0.75 [0.73-0.76], 0.67 [0.65-0.68], 0.66 [0.70-0.73]; P<.001). Calibration plots showed excellent concordance between the predicted and actual SMM for the APEX scoring system and OB-CMI (both Hosmer-Lemeshow test P values=1.00, suggesting goodness-of-fit).
This study validated four risk-scoring systems to predict SMM. Both CMQCC and APEX scoring systems had good discrimination to predict SMM. The APEX score and the OB-CMI had goodness-of-fit. At ideal calculated cut-off points, the APEX score had the highest sensitivity of the four scores at 71%, indicating that better scoring systems are still needed for predicting SMM.
严重的产妇发病率（SMM）在美国呈上升趋势。有几种工具和评分系统可以对个体的 SMM 风险进行分层。
我们旨在检验和比较四种评分系统预测 SMM 的有效性。
这是一项对 2002 年至 2008 年期间参与安全分娩联合会数据集的所有个体进行的回顾性队列研究。如果个体的风险因素信息缺失，则将其排除在外。SMM 是根据疾病控制与预防中心的定义，排除输血。由于对国际疾病分类代码用于该指标的特异性及其可变临床意义的担忧，因此排除了输血。使用围产期卓越评估（APEX）、加利福尼亚产妇质量护理合作组织（CMQCC）、产科合并症指数（OB-CMI）和改良 OB-CMI 为每位参与者计算风险评分。根据风险评分计算 SMM 的概率。通过接收者操作特征曲线及其 95%置信区间（95%CI）下的面积来评估预测评分的判别性能。使用引导重采样比较每个评分的曲线下面积。为每个评分绘制校准图以检查拟合优度。使用一致性概率方法为表现最佳的评分定义最佳截断点。
在 153463 名个体中，有 1115 名（0.7%）发生了 SMM。CMQCC 评分系统的曲线下面积（95%CI）（0.78 [0.77-0.80]）显著高于 APEX 评分系统、OB-CMI 和改良 OB-CMI 评分系统（0.75 [0.73-0.76]、0.67 [0.65-0.68]、0.66 [0.70-0.73]；P<.001）。校准图显示，APEX 评分系统和 OB-CMI 的预测 SMM 与实际 SMM 之间具有极好的一致性（两者的 Hosmer-Lemeshow 检验 P 值均为 1.00，表明拟合优度良好）。
本研究验证了四种预测 SMM 的风险评分系统。CMQCC 和 APEX 评分系统均具有良好的区分能力来预测 SMM。APEX 评分和 OB-CMI 具有良好的拟合优度。在理想的计算截断点处，APEX 评分的敏感性最高，为 71%，表明仍需要更好的评分系统来预测 SMM。
