Improving accuracy of outcome prediction for infants born extremely preterm using a digital tool: Translating ‘NIC‐PREDICT’ into clinical practice, the first steps

Abstract

BackgroundMany clinicians overestimate mortality and disability rates in infants born extremely preterm. We developed a digital tool (‘NIC‐PREDICT’) that predicts infant mortality and survival with and without major disability in infants born 23–27 weeks' gestation.AimsTo determine if clinicians could use NIC‐PREDICT accurately, and if their perceptions of infant outcomes improved after its release in 2021.Materials and MethodsMidwives, nurses, obstetricians, neonatologists and paediatricians working in tertiary and non‐tertiary hospitals in Victoria were asked to use NIC‐PREDICT to estimate three mutually exclusive outcomes: (i) mortality; (ii) survival free of major disability; and (iii) survival with major disability for six different scenarios where a liveborn infant was offered survival‐focused care after birth. The proportions who completed the survey (responded to all six scenarios) and the proportions able to provide 100% accurate results for all scenarios were determined. Estimates of the three outcomes were compared with true rates.ResultsA total of 85 clinicians responded: 70 (82%) completed the survey, with an overall accuracy of 76%. Overall, predictions of mortality were accurate (mean difference from true value 0.7% (95% confidence interval (CI) −0.7, 2.1) P = 0.33), as were predictions of survival without major disability (mean difference − 0.7 (95% CI –3.0, 1.7) P = 0.58). However, survival with major disability was overestimated by 4.9% ((95% CI 1.7, 8.0) P = 0.003).ConclusionsMost perinatal clinicians who responded used NIC‐PREDICT correctly to estimate expected outcomes in infants born extremely preterm who are offered intensive care. Undue pessimism about survival with major disability remains an ongoing concern.