{
  "abstract": "Background/aims This study represents an external validation with model updating of the online DIGIROP-Prescreen and DIGIROP-Screen 2.0 prediction models, incorporating ≥14 days of parenteral nutrition as an additional predictor, to identify infants requiring treatment for retinopathy of prematurity (ROP) in a contemporary Swedish cohort, estimate potential cost savings and compare DIGIROP performance with other models.Methods Infants born in Sweden, 2021 –2023 (n=1530) were evaluated. ROP and neonatal data were retrieved from Swedish quality registers. Sensitivity, specificity and the area under the receiver operating characteristic (AUC) curve were calculated. In the Västra Götaland Region cohort (n=245), the DIGIROP models were compared with WINROP and two Postnatal Growth and ROP (G-ROP) models. We estimated DIGIROP models’ cost-saving.Results The mean gestational age was 27.7 (SD 2.2) weeks, birth weight 1029 (SD 317) g, 689 (45.0%) were girls and 85 (5.6%) infants received ROP treatment. For DIGIROP-Prescreen 2.0, the AUC was 0.89 (95% CI 0.86 to 0.92), sensitivity was 100% (95% CI 95.8% to 100%) and specificity 27.5% (95% CI 25.3% to 29.9%). For DIGIROP-Screen 2.0, the cumulative specificity increased from 27.7% to 67.8% between postnatal weeks 6–14, with a sensitivity of 100%. In total, ∼Int$750 000 could have been saved in screening costs in Sweden during 2021–2023 using DIGIROP models. DIGIROP-Screen at postnatal age 10 weeks had the same sensitivity but higher specificity than G-ROP. WINROP showed lower sensitivity but the highest specificity.Conclusion DIGIROP 2.0 demonstrated high sensitivity and the most robust discrimination for treatment-requiring ROP in a contemporary Swedish cohort, compared with other models, with the potential to reduce unnecessary eye examinations and healthcare costs.",
  "authors": [
    {
      "affiliations": [
        "Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden",
        "Department of Ophthalmology, Sahlgrenska University Hospital, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden"
      ],
      "name": "Aldina Pivodic"
    },
    {
      "affiliations": [
        "Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden",
        "Department of Ophthalmology, Sahlgrenska University Hospital, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden"
      ],
      "name": "Berg Karin"
    },
    {
      "affiliations": [
        "Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Jenny Wallander"
    },
    {
      "affiliations": [
        "The Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Lois Smith"
    },
    {
      "affiliations": [
        "Department of Surgical Sciences, Ophthalmology, Uppsala University, Uppsala, Sweden"
      ],
      "name": "Eva Larsson"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Örebro University Hospital, Örebro, Sweden"
      ],
      "name": "Despina Tsamadou"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden"
      ],
      "name": "Karin Sandgren Hochhard"
    },
    {
      "affiliations": [
        "Department of Clinical Neuroscience, Section for Eye and Vision, Karolinska Institute, Stockholm, Sweden",
        "Department of Pediatric Ophthalmology, St Erik Eye Hospital, Stockholm, Sweden"
      ],
      "name": "Kristina Teär Fahnehjelm"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden"
      ],
      "name": "Lotta Gränse"
    },
    {
      "affiliations": [
        "Department of Surgical Sciences, Ophthalmology, Uppsala University, Uppsala, Sweden"
      ],
      "name": "Gerd E Holmstrom"
    },
    {
      "affiliations": [
        "Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden",
        "Department of Ophthalmology, Sahlgrenska University Hospital, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden"
      ],
      "name": "Ann Hellström"
    },
    {
      "affiliations": [
        "Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden",
        "Department of Ophthalmology, Sahlgrenska University Hospital, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden"
      ],
      "name": "Pia Lundgren"
    }
  ],
  "title": "External validation and updating of DIGIROP prediction models including parenteral nutrition for treatment-requiring retinopathy of prematurity in a Swedish national cohort",
  "uid": "ade87aff-22c8-536b-9211-0e4e4a4dba9f"
}