816 Comparative analysis of obstetric hemorrhage risk prediction tools

Abstract

Hemorrhage risk prediction tools were developed in response to rising rates of obstetric hemorrhage (OBH). The California Maternal Quality Care Collaborative (CMQCC) risk prediction tool classifies patients as low, medium, and high risk for OBH. At our institution, a unique OBH risk predictor tool was derived from the CMQCC tool by adding a weighted value to individual risk factors. Our objective is to compare an enhanced institution-specific (IS) OBH risk prediction tool to the CMQCC OBH risk prediction tool. Retrospective cohort of delivery admissions from 2018 to 2019 at our institution. Admission OBH risk scores were assigned to each patient using both the IS and CMQCC score. Cohen’s Kappa estimated agreement. Scoring systems and maternal outcomes were compared using Chi-square test. Composite morbidity included transfusion, hysterectomy, uterine artery embolization, and ICU admission. 25,957 delivery admissions were included. A moderate association was observed between scoring systems (Kappa 0.41, p<0.001). The IS score categorized patients as low (60%), medium (37%), and high (3%) risk. The CMQCC score categorized patients as low (74%), medium (22%), and high (4%) risk. Both the IS score and the CMQCC score were able to differentiate OBH related morbidity across risk strata (Table 1). The IS score re-categorized CMQCC low risk patients to a higher risk stratum 26% of the time. CMQCC high risk patients were re-categorized to a lower risk stratum 86% of the time. The IS score independently predicted risk of composite OBH related morbidity within each stratum of the CMQCC score (Table 2). Notably, a composite event occurred in 11.6% of women with a low CMQCC and high IS score compared to 1.1% with both a low CMQCC and IS score. Both the IS and CMQCC score independently distinguish risk of composite morbidity and are valid predictors of OBH. Adding weighted values to individual risk factors further discriminates risk of morbidity. This suggests it may be reasonable to adapt the CMQCC’s score to more effectively reflect institutional populations and resources.View Large Image Figure ViewerDownload Hi-res image Download (PPT)