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Validation of DIGIROP models and decision support tool for prediction of treatment for retinopathy of prematurity on a contemporary Swedish cohort.

  • Pivodic, Aldina1
  • E H Smith, Lois2
  • Hård, Anna-Lena3
  • Löfqvist, Chatarina3, 4
  • Almeida, Ana Catarina5, 6, 7, 8, 9
  • Al-Hawasi, Abbas10
  • Larsson, Eva11
  • Lundgren, Pia3
  • Sunnqvist, Birgitta12
  • Tornqvist, Kristina13
  • Wallin, Agneta14
  • Holmstrom, Gerd11
  • Gränse, Lotta13
  • 1 Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden [email protected]. , (Sweden)
  • 2 Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • 3 Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. , (Sweden)
  • 4 Institute of Health Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. , (Sweden)
  • 5 Department of Ophthalmology, Hospital Beatriz Angelo, Loures, Portugal. , (Portugal)
  • 6 Neonatal Intensive Care Unit, Hospital São Francisco Xavier-Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal. , (Portugal)
  • 7 CEDOC, Chronic Diseases Research Center, NOVA Medical School - Universidade Nova de Lisboa, Lisbon, Portugal. , (Portugal)
  • 8 Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal. , (Portugal)
  • 9 Department of Ophthalmology, Luz Saúde, Hospital da Luz, Lisbon, Portugal. , (Portugal)
  • 10 Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. , (Sweden)
  • 11 Department of Surgical Sciences/Ophthalmology, Uppsala University, Uppsala, Sweden. , (Sweden)
  • 12 Länssjukhuset Ryhov, Jönköping, Sweden. , (Sweden)
  • 13 Department of Clinical Sciences, Ophthalmology, Skane University Hospital, Lund University, Lund, Sweden. , (Sweden)
  • 14 St. Erik Eye Hospital, Stockholm, Sweden. , (Sweden)
Published Article
British Journal of Ophthalmology
Publication Date
Aug 01, 2023
DOI: 10.1136/bjophthalmol-2021-320738
PMID: 35277395


Retinopathy of prematurity (ROP) is currently diagnosed through repeated eye examinations to find the low percentage of infants that fulfil treatment criteria to reduce vision loss. A prediction model for severe ROP requiring treatment that might sensitively and specifically identify infants that develop severe ROP, DIGIROP-Birth, was developed using birth characteristics. DIGIROP-Screen additionally incorporates first signs of ROP in different models over time. The aim was to validate DIGIROP-Birth, DIGIROP-Screen and their decision support tool on a contemporary Swedish cohort. Data were retrieved from the Swedish national registry for ROP (2018-2019) and two Swedish regions (2020), including 1082 infants born at gestational age (GA) 24 to <31 weeks. The predictors were GA at birth, sex, standardised birth weight and age at the first sign of ROP. The outcome was ROP treatment. Sensitivity, specificity and area under the receiver operating characteristic curve (AUC) with 95% CI were described. For DIGIROP-Birth, the AUC was 0.93 (95% CI 0.90 to 0.95); for DIGIROP-Screen, it ranged between 0.93 and 0.97. The specificity was 49.9% (95% CI 46.7 to 53.0) and the sensitivity was 96.5% (95% CI 87.9 to 99.6) for the tool applied at birth. For DIGIROP-Screen, the cumulative specificity ranged between 50.0% and 78.7%. One infant with Beckwith-Wiedemann syndrome who fulfilled criteria for ROP treatment and had no missed/incomplete examinations was incorrectly flagged as not needing screening. DIGIROP-Birth and DIGIROP-Screen showed high predictive ability in a contemporary Swedish cohort. At birth, 50% of the infants born at 24 to <31 weeks of gestation were predicted to have low risk of severe ROP and could potentially be released from ROP screening examinations. All routinely screened treated infants, excluding those screened for clinical indications of severe illness, were correctly flagged as needing ROP screening. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

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