Validation of a Scoring System for Near-Miss (Life-Threatening) Maternal Morbidity
Sullivan, M. T., Bender, R. H., Sathe, N. S., & Spagnola, K. E. (2007, November). Validation of a Scoring System for Near-Miss (Life-Threatening) Maternal Morbidity. Presented at American Public Health Association Annual Meeting 2007, Washington, DC.
Introduction: The ability to study near-miss maternal morbidity (NM) allows researchers to better understand ways to prevent deaths and decrease morbidity during pregnancy. The objective of this work was to validate a published scoring system designed to identify women with NM at delivery1-2 by comparing its results to those produced from scoring a different dataset.Methods: The authors used a clinical database including all 1990-2004 deliveries at a tertiary care center in Washington DC. Experienced clinicians made morbidity determinations by review of case information for 443 deliveries that included all those with moderate or greater morbidity. The previously published scoring system was applied to these cases and the sensitivity and specificity of each of the 7 options was compared to previously published values.Results: Each of the 7 options had sensitivity similar to those previously published in the ability to distinguish NM cases from those with severe or moderate morbidity. Five options (those with > 2 factors) achieved 100% sensitivity. The option that included all 5 factors had the best performance: 100% sensitivity and 80% specificity. Specificities ranged from 66-83%, and for 6 options were significantly lower than published values.Conclusions: The authors concluded that the published scoring system developed to identify NM was valid in a large delivery population, accepting that sensitivity is more important than specificity for identifying NM. This scoring system may be useful for quality assurance purposes, monitoring trends in maternal morbidity, epidemiologic study, resource planning, and health services research.