Validation of an obstetric comorbidity index in an external population

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 122; no. 13; pp. 1748 - 1755
• Main Authors: Metcalfe, A, Lix, LM, Johnson, J‐A, Currie, G, Lyon, AW, Bernier, F, Tough, SC
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-12-2015; John Wiley and Sons Inc
• Subjects: Adult; Area Under Curve; Canada - epidemiology; Comorbidity; Delivery, Obstetric - statistics & numerical data; Epidemiology; Female; Hospitalization; Humans; International Classification of Diseases; Length of Stay - statistics & numerical data; Logistic Models; Obstetric Labor Complications - epidemiology; Obstetrics; Outcome Assessment, Health Care - standards; Pregnancy; prevalence; Severity of Illness Index; validation; Validation studies; Canada; International Classification of Diseases; prevalence; Comorbidity; validation; pregnancy
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.13254

Objectives
An obstetric comorbidity index has been developed recently with superior performance characteristics relative to general comorbidity measures in an obstetric population. This study aimed to externally validate this index and to examine the impact of including hospitalisation/delivery records only when estimating comorbidity prevalence and discriminative performance of the obstetric comorbidity index.
Design
Validation study.
Setting
Alberta, Canada.
Population
Pregnant women who delivered a live or stillborn infant in hospital (n = 5995).
Methods
Administrative databases were linked to create a population‐based cohort. Comorbid conditions were identified from diagnoses for the delivery hospitalisation, all hospitalisations and all healthcare contacts (i.e. hospitalisations, emergency room visits and physician visits) that occurred during pregnancy and 3 months pre‐conception. Logistic regression was used to test the discriminative performance of the comorbidity index.
Main outcome measures
Maternal end‐organ damage and extended length of stay for delivery.
Results
Although prevalence estimates for comorbid conditions were consistently lower in delivery records and hospitalisation data than in data for all healthcare contacts, the discriminative performance of the comorbidity index was constant for maternal end‐organ damage [all healthcare contacts area under the receiver operating characteristic curve (AUC) = 0.70; hospitalisation data AUC = 0.67; delivery data AUC = 0.65] and extended length of stay for delivery (all healthcare contacts AUC = 0.60; hospitalisation data AUC = 0.58; delivery data AUC = 0.58).
Conclusions
The obstetric comorbidity index shows similar performance characteristics in an external population and is a valid measure of comorbidity in an obstetric population. Furthermore, the discriminative performance of the comorbidity index was similar for comorbidities ascertained at the time of delivery, in hospitalisation data or through all healthcare contacts.