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Evaluation and validation of a prediction model for extubation success in very preterm infants

Abstract

Objective

To perform an external validation of a publicly available model predicting extubation success in very preterm infants.

Study design

Retrospective study of infants born <1250 g at a single center. Model performance evaluated using the area under the receiver operating characteristic curve (AUROC) and comparing observed and expected probabilities of extubation success, defined as survival ≥5 d without an endotracheal tube.

Results

Of 177 infants, 120 (68%) were extubated successfully. The median (IQR) gestational age was 27 weeks (25–28) and weight at extubation was 915 g (755–1050). The model had acceptable discrimination (AUROC 0.72 [95% CI 0.65–0.80]) and adequate calibration (calibration slope 0.96, intercept -0.06, mean observed-to-expected difference in probability of extubation success −0.08 [95% CI −0.01, −0.15]).

Conclusions

The extubation success prediction model has acceptable performance in an external cohort. Additional prospective studies are needed to determine if the model can be improved or how it can be used for clinical benefit.

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Fig. 1: ROC curve and calibration plot.
Fig. 2: Classification of reduced and expanded models.

Data availability

The corresponding author can be contacted for source data.

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Authors and Affiliations

Authors

Contributions

BD conceived of and designed the study, acquired data and drafted the manuscript, AS and VS acquired data and critically revised the manuscript for important intellectual content, RG, MR, and SC guided analyses and interpretation of data and critically revised the manuscript for important intellectual content and RP conceived of and designed the study, analyzed the data, drafted the manuscript and provided study supervision.

Corresponding author

Correspondence to Ravi M. Patel.

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The authors declare no competing interests.

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Dryer, R.A., Salem, A., Saroha, V. et al. Evaluation and validation of a prediction model for extubation success in very preterm infants. J Perinatol (2022). https://doi.org/10.1038/s41372-022-01517-z

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