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UBC Theses and Dissertations

Development, validation and pilot implementation of the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) clinical risk prediction model Payne, Beth


The hypertensive disorders of pregnancy (HDPs) are one of the leading causes of maternal death and morbidity in low-resourced countries due to delays in case identification and a shortage of health workers trained to manage these disorders. The objective of this thesis was to develop an evidence-based tool that could aid community-based health workers in decision making around the care of women with the HDPs. This objective was achieved using a prospective cohort of data collected in five low and middle income countries (LMICs) to: (1) develop a clinical risk predication model using logistic regression (the “miniPIERS” model); (2) validate the miniPIERS model through bootstrapping and by applying the model to a second cohort of women with HDP; (3) extend and recalibrate the model to include the novel biomarker, pulse oximetry (SpO₂); and (4) translate the miniPIERS model into a decision rule for final creation of the PIERS on the Move decision algorithm. All stages of development of the PIERS on the Move tool included input from stakeholders in low-resourced countries. The miniPIERS model, based on demographics, symptoms and clinical signs, accurately identified women who were at greatest risk of complications from the HDP (AUC ROC 0.77 [95% CI 0.74 – 0.80]). Internal validation demonstrated minimal overfitting with an average optimism of 0.037. Addition of SpO2 to the miniPIERS model resulted in a 20% increase in classification accuracy of high-risk women. Using an iterative review and feedback process including stakeholders from our partner low-resourced countries, decision points defined by the miniPIERS model were combined with the WHO recommendations for treatment of women with HDP to create a novel decision algorithm for population level risk screening. This decision algorithm identified high-risk women in the miniPIERS cohort with a sensitivity of 74.1% and specificity of 51.4%. Pilot testing of this tool in South Africa demonstrated potential impact but the true impact of use of the PIERS on the Move tool on maternal outcome rates requires assessment through an implementation study.

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