155103 Validation of a scoring system for near-miss (life-threatening) maternal morbidity

Monday, November 5, 2007: 11:05 AM

Marian T. Sullivan, MS, MPH , Statistics and Epidemiology, Research Triangle International, Rockville, MD
Ayman El-Mohandes, MD, MBBCh, MPH , Department of Prevention and Community Health, Departments of Obstetrics and Gynecology and Neonatology, George Washington University Medical Center, School of Medicine and Health Sciences, Washington, DC
Suzanne B. Zane, DVM , Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
Randall H. Bender, PhD , Statistics and Epidemiology, Research Triangle International, Research Triangle Park, NC
Afifa Klouj, MBA , Biostatistics Center, George Washington University Medical Center, Washington, DC
Charles Macri, MD , Division of Maternal-Fetal Medicine, George Washington University Medical Center, School of Medicine and Health Sciences, Washington, DC
Neeraja Sathe, MS , Statistics and Epidemiology, Research Triangle International, Research Triangle Park, NC
Susan Bathgate, MD , Division of Maternal-Fetal Medicine, George Washington University Medical Center, School of Medicine and Health Sciences, Washington, DC
Philip J. Urso, MD , Quality Assurance Consultant for Obstetrics and Gynecology, George Washington University Medical Center, School of Medicine and Health Sciences, Washington, DC
Kathryn W. Spagnola, MS , Statistics and Epidemiology, Research Triangle International, Research Triangle Park, NC
           
The ability to study near-miss maternal morbidity (NM) allows researchers to better understand ways to prevent deaths and decrease pregnancy-related morbidity. Our objective was to validate a published scoring system (1) designed to identify women with NM at delivery by comparing its results to those produced from scoring a different dataset. The scoring system used 7 different combinations of 5 clinical factors: organ failure, extended intubation, ICU admission, surgical intervention, and blood transfusion.

We used a clinical database including all 1990-2004 deliveries at a tertiary care center in Washington DC. Experienced clinicians made morbidity determinations by review of case information for 443 deliveries that included all those with moderate or greater morbidity. The scoring system was applied to these cases and the sensitivity and specificity of each of the 7 options was compared to previously published values.

Each of the 7 options had sensitivity similar to those previously published in the ability to distinguish NM cases from those with moderate or severe morbidity. Five options achieved 100% sensitivity. The option that included all 5 factors had the best performance: 100% sensitivity and 80% specificity. Specificities ranged from 66-83%, and for 6 options were significantly lower than published values.

We concluded that the published scoring system developed to identify NM was valid in a large delivery population, accepting that sensitivity is more important than specificity for identifying NM. This scoring system may be useful for quality assurance purposes, monitoring trends in maternal morbidity, epidemiologic study, resource planning, and health services research.

Learning Objectives:
1)Articulate the concept of near-miss maternal morbidity. 2)Describe the procedures used for validating this scoring system and for scoring clinical data. 3)Discuss the usefulness of a scoring system that can identify rare clinical outcomes from large datasets.

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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