Validation of a Scoring System to Identify Women with Near-Miss Maternal Morbidity

Abstract

Objective To validate a five-factor scoring system that identifies parturients who experience near-miss morbidity.

Study Design and Setting This study was conducted in an urban, tertiary care hospital over a 2-year period. A narrative case summary was prepared for women with high potential for significant obstetric morbidity. The summary was then reviewed by three physicians, and the extent of morbidity was assigned based on subjective assessment. The same cases were then scored using the proposed five-factor scoring system previously described by Geller et al. Test characteristics of the scoring system were assessed.

Results Eight hundred fifteen cases with a high potential for significant morbidity were identified. Subjective review and the scoring system classified 4.5% and 4.2% as near-miss morbidity, respectively, with the scoring system having a corresponding sensitivity of 81.1% (95% confidence interval 64.8 to 92.0%) and a specificity of 99.5% (95% confidence interval 98.7 to 99.9%).

Conclusion The scoring system produced similar results to those obtained at its initial development and demonstrated acceptable sensitivity and specificity for identifying near-miss morbidity.

Keywords

near-miss morbidity - maternal mortality - scoring system

Notes

Research for this project was done while the author (Whitney B. You, M.D., M.P.H.) was a National Research Service Award postdoctoral fellow at the Institute for Healthcare Studies under an institutional award from the Agency for Healthcare Research and Quality (T-32 HS 000078–11).

A related abstract was presented as a poster at the 2009 Society of Maternal Fetal Medicine meeting in San Diego, California, and the 2009 Academy of Health Annual Meeting in Chicago, Illinois.

• References

• 1 Chang J, Elam-Evans LD, Berg CJ , et al. Pregnancy-related mortality surveillance—United States, 1991–1999. MMWR Surveill Summ 2003; 52: 1-8
• 2 Hogan MC, Foreman KJ, Naghavi M , et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010; 375: 1609-1623
• 3 Callaghan WM, Mackay AP, Berg CJ. Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991–2003. Am J Obstet Gynecol 2008; 199: 133 , e1–e8
• 4 Geller SE, Rosenberg D, Cox S, Brown M, Simonson L, Kilpatrick S. A scoring system identified near-miss maternal morbidity during pregnancy. J Clin Epidemiol 2004; 57: 716-720
• 5 Bouvier-Colle MH. Maternal intensive care and near-miss mortality in obstetrics. Br J Obstet Gynaecol 1999; 106: 1229-1234
• 6 Baskett TF, Sternadel J. Maternal intensive care and near-miss mortality in obstetrics. Br J Obstet Gynaecol 1998; 105: 981-984