Challenges In Identifying High Risk Patients For Preeclampsia Using Uspstf Guidelines

Thomas McElrath, MD, PhD, of nan Department of Obstetrics & Gynecology astatine Brigham & Women’s Hospital, is nan lead and corresponding writer of a insubstantial published in JAMA Network Open, "Utility of nan US Preventive Services Task Force for Preeclampsia Risk Assessment and Aspirin Prophylaxis."

Q: How would you summarize your study for a laic audience?

Dr. McElrath: Preeclampsia (PE) is simply a hypertensive illness that complicates 7-10% of pregnancies. While caller advances successful knowing nan underlying causes of PE person been made, predicting its occurrence has historically been difficult because it is simply a analyzable information that apt results from a assortment of causes and tin coming successful different ways.

To reside this challenge, nan United States Preventive Services Task Force (USPSTF) reviewed a bid of PE-associated studies to create a group of consequence factors to assistance successful characterizing diligent consequence of PE. However, since these consequence factors were identified successful individual and abstracted studies, they person not been evaluated arsenic a full to spot really effective they are astatine stratifying consequence wrong a single, divers diligent population.

We aimed to measure really good these guidelines thief physicians place patients astatine consequence of PE and if those patients who were identified arsenic being at-risk patients were directed to return aspirin arsenic a preventative measure.

We recovered that utilizing nan USPSTF guidelines identified 89% of participants arsenic being astatine either mean aliases precocious consequence for PE. With nan immense mostly of nan organization being branded arsenic "at risk," it is unclear if nan USPSTF guidelines are serving their intended usage of helping clinicians place patients astatine astir request of further care.

Furthermore, we recovered that only 37% of nan participants who were identified arsenic being astatine mean consequence were receiving nan recommended prophylaxis of 1 low-dose aspirin per day, suggesting a spread still exists betwixt consequence recognition and relationship to preventative care.

Q: What mobility were you investigating?

How good do nan consequence appraisal guidelines for preeclampsia that were developed by nan USPTF activity successful identifying those astatine accrued consequence of preeclampsia?

Subsequently, really galore of those individuals identified astatine accrued consequence are receiving a medicine of aspirin prophylaxis, arsenic recommended by nan American College of Obstetricians and Gynecologists and nan Society of Maternal-Fetal Medicine?

Q: What methods aliases attack did you use?

We approached and enrolled 5,600+ individuals pinch singleton pregnancies who met nan inclusion criteria for nan study astatine 11 different centers successful geographically divers area of nan United States.

For nan purposes of nan study, we defined individuals arsenic being successful nan high-risk class if they had astatine slightest 1 precocious consequence facet (as identified by nan USPTF). Individuals were defined arsenic being successful nan mean consequence class if they had astatine slightest 1 of nan mean consequence factors, but nary high-risk factors. Participants were defined arsenic being successful nan low-risk class if they had nary mean aliases high-risk factors.

Q: What did you find?

Using nan USPTF screening guidelines, we recovered that 18% of participants were successful nan high-risk category, 71% of participants were successful nan mean consequence class and 11% were successful nan low-risk category.

These categories were truthful labeling 89% of nan organization arsenic astatine mean aliases precocious consequence for PE.

With nan mostly of nan organization being branded arsenic risk, it is unclear if nan USPSTF guidelines are serving their intended usage of assisting clinicians successful stratifying preeclampsia risk.

The existent rates of PE for each of nan 3 categories were arsenic follows:

• 0% for those identified arsenic debased risk
• 5% for those astatine mean risk
• 5% for those astatine precocious risk

While nan mostly of patients (82%) astatine precocious consequence for PE received a proposal for aspirin prophylaxis, patients astatine mean consequence for PE received recommendations astatine overmuch little rates.

Only astir half of nan patients pinch 2 aliases much mean consequence factors received recommendations for an aspirin prophylaxis while little than 25% of patients pinch 1 consequence facet received a proposal for aspirin.

Q: What are nan implications?

If nan intended inferior of nan guidelines is to facilitate nan attraction of objective attraction and constricted objective resources connected those astatine top consequence of preeclampsia, identifying nan mostly of nan organization arsenic "at risk" does not meet this end.

Q: What are nan adjacent steps?

The consequence factors for PE, and astir apt different conditions, should beryllium simultaneously evaluated successful a azygous population, not conscionable compiled from nan results of abstracted and individual studies, to guarantee that they supply clinically actionable accusation that tin assistance pinch diligent consequence stratification and nan alignment of objective resources.