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Validation of the Colorado Retinopathy of Prematurity Screening Model
Emily A McCourt1, Gui-Shuang Ying2, Anne M Lynch1
1Department of Ophthalmology, University of Colorado School of Medicine, Aurora.
Insights
The Colorado Retinopathy of Prematurity (CO-ROP) model shows high sensitivity for predicting severe ROP but requires revision. It missed some infants needing treatment, indicating a need for refinement before clinical use.
Area of Science:
- Neonatology
- Ophthalmology
- Perinatal Medicine
Background:
- The Colorado Retinopathy of Prematurity (CO-ROP) model predicts severe ROP risk using birth weight, gestational age, and weight gain.
- Previous studies showed high performance, suggesting potential to reduce ROP examinations.
- Validation in a larger, diverse population is warranted.
Purpose of the Study:
- To validate the CO-ROP model's performance in a large, multicenter cohort.
- Assess the model's sensitivity and specificity for severe ROP.
- Evaluate the potential reduction in infants requiring ROP examinations.
Main Methods:
- Secondary analysis of the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study data.
- Retrospective cohort study of 6351 premature infants across 29 US and Canadian hospitals (2006-2012).
- Applied CO-ROP criteria (birth weight, gestational age, weight gain at 28 days) to predict severe ROP (ETROP type 1 or 2).
Main Results:
- The CO-ROP model achieved 96.9% sensitivity and 40.9% specificity for severe ROP.
- It correctly identified most severe ROP cases but missed 3.1% of affected infants.
- The model could have reduced ROP examinations by 26.1%.
Conclusions:
- The CO-ROP model demonstrates high sensitivity but is not 100% accurate for severe ROP.
- Some infants with severe ROP were missed, particularly those with atypical weight gain.
- Model revision is necessary before clinical implementation to improve detection accuracy.
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 they met all 3 criteria: birth weight, <1501 g; gestational age, <30 weeks; and WG-28, <650 g). Infants missing WG-28 information were included in a secondary analysis in which WG-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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