Validation of the Colorado retinopathy of prematurity screening model

G-ROP Study Group

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)409-416
Number of pages8
JournalJAMA Ophthalmology
Volume136
Issue number4
DOIs
StatePublished - Apr 1 2018

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Retinopathy of Prematurity
Birth Weight
Gestational Age
Weight Gain
Cohort Studies
Growth

ASJC Scopus subject areas

  • Ophthalmology

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Validation of the Colorado retinopathy of prematurity screening model. / G-ROP Study Group.

In: JAMA Ophthalmology, Vol. 136, No. 4, 01.04.2018, p. 409-416.

Research output: Contribution to journalArticle

G-ROP Study Group. / Validation of the Colorado retinopathy of prematurity screening model. In: JAMA Ophthalmology. 2018 ; Vol. 136, No. 4. pp. 409-416.
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abstract = "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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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 Kimzey

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

PY - 2018/4/1

Y1 - 2018/4/1

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

VL - 136

SP - 409

EP - 416

JO - JAMA Ophthalmology

JF - JAMA Ophthalmology

SN - 2168-6165

IS - 4

ER -