OP37.04: Multidisciplinary prediction on likelihood of primary closure for an omphalocele

Abstract

Objectives: To compare predictive performance of obstetric physicians (OP) vs. pediatric physicians (PP), judging standardized high quality US images of omphalocele in terms of the likelihood of primary surgical closure. To establish the key information guiding that judgment. Methods: Cases with an omphalocele, isolated or with minor anomalies, with ≥1 complete investigation between 12–23 weeks of gestation (n = 21) were drawn from our US database. Additional prenatal characteristics and postnatal outcome data were collected. We devised a standardized presentation of each case on a form, providing: images, image related data (defect O; 2 ratios: cele circumference/abdominal circumference and defect O/abdominal O), and prenatal data. Respondents were required to state the likelihood of primary closure in terms of quantitative probability (6 range categories: 0–20%, 20–40%, 40–60% and 80–100%) An ‘unable to predict’ category was included. Respondents were: 10 OP vs. 9 PP. All respondents were blinded towards the patient and unaware of postnatal outcome. Results: The 19 physicians provided 399 answers for 21 cases (complete). In retrospect primary closure was observed in 13/21, and predicted correctly (majority of respondents predicted 60% or more answer) in 5/13 cases. In the remaining 8/21 cases of non closure, in 1/8 the majority predicted failure (20% or less answer). From a predictive point of view, in 92% of the >60% responses, this prediction was correct. However, in only 60% of the <20% predictions, primary closure actually failed. Prediction failure did not differ according to specialty, yet individuals showed pessimism/optimism differences. Individual accuracy ranged from 2/21 to 13/21. The cele content was the primary information tag according to 17/19 respondents, while only 4/19 mentioned the diameter and 8/19 the ratios. Conclusions: Antenatal judgment on primary closure of an omphalocele by OP and PP shows no inter-professional differences. However, these experts were too pessimistic as 40% predicted non closures actually closed. This may affect counseling results.