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Development and Validation of a Risk Scoring Tool to Predict Respiratory Syncytial Virus Hospitalization in Premature Infants Born at 33 through 35 Completed Weeks of Gestation

Department of Surgery and Medicine, McGill University and JSS Medical Research Inc., Montreal, Quebec, Canada

Joanne Langley, MSc, MD, FRCPC

Departments of Pediatrics and Community Health and Epidemiology, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada

Xavier Carbonell-Estrany, MD, PhD

Neonatology Service, Hospital Clinic, Institut Clinic Ginecologia Obstetricia i Neonatologia, Universidad de Barcelona, Barcelona, Spain

Bosco Paes, MBBS, FRCPC

Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada

Karel O'Brien, MBBCh, BAO, FRCPC

Department of Pediatrics, University of Toronto and Mount Sinai Hospital, Toronto, Ontario, Canada

Upton Allen, MBBS, FRCPC

Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada

Ian Mitchell, MA, MB, FRCPC

Department of Pediatrics, Alberta's Children's Hospital and University of Calgary, Calgary, Alberta, Canada

José Figueras Aloy, MD, PhD

Neonatology Service, Hospital Clinic, Institut Clinic Ginecologia Obstetricia i Neonatologia, Universidad de Barcelona, Barcelona, Spain

Carmen Pedraz, MD, PhD

Neonatology Service, Hospital Clinico, Salamanca, Spain

Andrea F. Michaliszyn, BA, DESS

Abbott Laboratories Limited, Montreal, Quebec, Canada

Objective. The purpose of the study was to develop and validate a clinical instrument predicting the risk of respiratory syncytial virus (RSV)-associated hospitalization (RSV-H) in premature infants born at 33 through 35 completed weeks of gestation (33—35GA). Design. An RSV risk scoring tool (RSV-RS) was developed by entering risk factors for RSV-H, determined in a Canadian prospective study, into a multiple logistic regression model. The scoring tool was then validated externally with data from a Spanish case-control study (FLIP). The Canadian cohort comprised 1758 RSV-positive infants born 33—35GA, of whom 66 (3.7%) had confirmed RSV-H. The FLIP data set comprised 186 (33.4%) RSV-H cases and 371 (66.7%) controls. Method. The primary outcome measure was RSV-H. The RSV-RS score was the sum of the weighted probabilities for each included risk factor multiplied by 100 and ranged from 0 to 100. Receiver operator characteristic curve analyses determined cutoff points to predict subjects at low, moderate, or high RSV-H risk. Results. The RSV-RS included 7 risk factors and cutoff scores of 0—48, 49—64, and 65— 100 for low-, moderate-, and high-risk subjects, respectively. For the Canadian cohort, RSV-RS sensitivity in predicting RSV-H cases was 68.2%, with 71.9% specificity. With the FLIP data set, the RSV-RS had lower accuracy (61.3% sensitivity; 65.8% specificity) but showed significant positive association with increased risk for RSV-H. Conclusion. The RSV-RS accurately identified 33—35GA infants at increased risk for RSV-H in a Canadian cohort. External validation with Spanish case-control study data further confirmed that the scoring tool is appropriate for the estimation of RSV-H risk.

Key Words: hospitalization • prematurity • respiratory syncytial virus • risk assessment • risk factors • scoring tool.

This version was published on July 1, 2008

Medical Decision Making, Vol. 28, No. 4, 471-480 (2008)
DOI: 10.1177/0272989X08315238


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