TY - JOUR
T1 - Validation of the Colorado retinopathy of prematurity screening model
AU - G-ROP Study Group
AU - McCourt, Emily A.
AU - Ying, Gui Shuang
AU - Lynch, Anne M.
AU - Palestine, Alan G.
AU - Wagner, Brandie D.
AU - Wymore, Erica
AU - Tomlinson, Lauren A.
AU - Binenbaum, Gil
AU - Duros, Trang B.
AU - Maguire, Maureen G.
AU - Brightwell-Arnold, Mary
AU - Shaffer, James
AU - Blanco, Maria
AU - Brown, Trina
AU - Helker, Christopher P.
AU - Barry, Gerard P.
AU - Fisher, Marilyn
AU - Battaglia, Maria V.
AU - Drach, Alex M.
AU - Donohue, Pamela
AU - Repka, Michael X.
AU - Doherty, Megan
AU - Dow, Dorothy
AU - Shepard, Jennifer A.
AU - Reynolds, James D.
AU - Connelly, Erin
AU - Cheeseman, Edward
AU - Bradham, Carol
AU - McAlpine, Allison
AU - Sunthankar, Sudeep
AU - Shirer, Kinsey
AU - Abbasian, Javaneh
AU - Lim, Janet
AU - Yang, Michael
AU - Alfano, Elizabeth L.
AU - Cobb, Patricia
AU - Rogers, David
AU - Fellows, Rae R.
AU - Loh, Kaitlyn
AU - McGregor, Madeline A.
AU - Mustafa, Thabit
AU - Reem, Rachel E.
AU - Russell, Tess
AU - Stattler, Rebecca
AU - Oravec, Sara
AU - Young, David
AU - Siu, Andrea
AU - Kanemori, Michele
AU - Wang, Jingyun
AU - Haider, Kathryn
N1 - Funding Information:
Funding/Support: This work was supported by the National Institutes of Health grant R01EY021137.
Funding Information:
This work was supported by the National Institutes of Health grant R01EY021137.
Publisher Copyright:
© 2018 American Medical Association. All rights reserved.
PY - 2018/4
Y1 - 2018/4
N2 - IMPORTANCE The Colorado Retinopathy of Prematurity (CO-ROP) model uses birth weight, gestational age, and weight gain at the first month of life (WG-28) to predict risk of severe retinopathy of prematurity (ROP). In previous validation studies, the model performed very well, predicting virtually all cases of severe ROP and potentially reducing the number of infants who need ROP examinations, warranting validation in a larger, more diverse population. OBJECTIVE To validate the performance of the CO-ROP model in a large multicenter cohort. DESIGN, SETTING, PARTICIPANTS This study is a secondary analysis of data from the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study, a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada between January 2006 and June 2012 of 6351 premature infants who received ROP examinations. MAIN OUTCOMES AND MEASURES Sensitivity and specificity for severe (early treatment of ROP [ETROP] type 1 or 2) ROP, and reduction in infants receiving examinations. The CO-ROP model was applied to the infants in the G-ROP data set with all 3 data points (infants would have received examinations if theymet all 3 criteria: birth weight, <1501 g; gestational age, <30 weeks; andWG-28, <650 g). Infants missingWG-28 information were included in a secondary analysis in whichWG-28 was considered fewer than 650 g. RESULTS Of 7438 infants in the G-ROP study, 3575 (48.1%) were girls, and maternal race/ethnicity was 2310 (31.1%) African American, 3615 (48.6%) white, 233 (3.1%) Asian, 40 (0.52%) American Indian/Alaskan Native, and 93 (1.3%) Pacific Islander. In the study cohort, 747 infants (11.8%) had type 1 or 2 ROP, 2068 (32.6%) had lower-grade ROP, and 3536 (55.6%) had no ROP. The CO-ROP model had a sensitivity of 96.9% (95%CI, 95.4%-97.9%) and a specificity of 40.9%(95%CI, 39.3%-42.5%). It missed 23 (3.1%) infants who developed severe ROP. The CO-ROP model would have reduced the number of infants who received examinations by 26.1%(95%CI, 25.0%-27.2%). CONCLUSIONS AND RELEVANCE The CO-ROP model demonstrated high but not 100% sensitivity for severe ROP and missed infants who might require treatment in this large validation cohort. The model requires all 3 criteria to be met to signal a need for examinations, but some infants with a birth weight or gestational age above the thresholds developed severe ROP. Most of these infants who were not detected by the CO-ROP model had obvious deviation in expected weight trajectories or nonphysiologic weight gain. These findings suggest that the CO-ROP model needs to be revised before considering implementation into clinical practice.
AB - IMPORTANCE The Colorado Retinopathy of Prematurity (CO-ROP) model uses birth weight, gestational age, and weight gain at the first month of life (WG-28) to predict risk of severe retinopathy of prematurity (ROP). In previous validation studies, the model performed very well, predicting virtually all cases of severe ROP and potentially reducing the number of infants who need ROP examinations, warranting validation in a larger, more diverse population. OBJECTIVE To validate the performance of the CO-ROP model in a large multicenter cohort. DESIGN, SETTING, PARTICIPANTS This study is a secondary analysis of data from the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study, a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada between January 2006 and June 2012 of 6351 premature infants who received ROP examinations. MAIN OUTCOMES AND MEASURES Sensitivity and specificity for severe (early treatment of ROP [ETROP] type 1 or 2) ROP, and reduction in infants receiving examinations. The CO-ROP model was applied to the infants in the G-ROP data set with all 3 data points (infants would have received examinations if theymet all 3 criteria: birth weight, <1501 g; gestational age, <30 weeks; andWG-28, <650 g). Infants missingWG-28 information were included in a secondary analysis in whichWG-28 was considered fewer than 650 g. RESULTS Of 7438 infants in the G-ROP study, 3575 (48.1%) were girls, and maternal race/ethnicity was 2310 (31.1%) African American, 3615 (48.6%) white, 233 (3.1%) Asian, 40 (0.52%) American Indian/Alaskan Native, and 93 (1.3%) Pacific Islander. In the study cohort, 747 infants (11.8%) had type 1 or 2 ROP, 2068 (32.6%) had lower-grade ROP, and 3536 (55.6%) had no ROP. The CO-ROP model had a sensitivity of 96.9% (95%CI, 95.4%-97.9%) and a specificity of 40.9%(95%CI, 39.3%-42.5%). It missed 23 (3.1%) infants who developed severe ROP. The CO-ROP model would have reduced the number of infants who received examinations by 26.1%(95%CI, 25.0%-27.2%). CONCLUSIONS AND RELEVANCE The CO-ROP model demonstrated high but not 100% sensitivity for severe ROP and missed infants who might require treatment in this large validation cohort. The model requires all 3 criteria to be met to signal a need for examinations, but some infants with a birth weight or gestational age above the thresholds developed severe ROP. Most of these infants who were not detected by the CO-ROP model had obvious deviation in expected weight trajectories or nonphysiologic weight gain. These findings suggest that the CO-ROP model needs to be revised before considering implementation into clinical practice.
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U2 - 10.1001/jamaophthalmol.2018.0376
DO - 10.1001/jamaophthalmol.2018.0376
M3 - Article
C2 - 29543944
AN - SCOPUS:85045552038
SN - 2168-6165
VL - 136
SP - 409
EP - 416
JO - JAMA ophthalmology
JF - JAMA ophthalmology
IS - 4
ER -