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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

^* To whom correspondence should be addressed. E-mail: jsampalis{at}jssresearch.com.

	Abstract

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. (Med Decis Making XXXX;XX:xx–xx)

First published on June 12, 2008, doi:10.1177/0272989X08315238

Medical Decision Making 2008;28:471.

A more recent version of this article appeared on July 1, 2008


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