title: Validation of an obstetric comorbidity index in an external population.
abstract: OBJECTIVE
  An obstetric comorbidity index has been developed recently with superior performance characteristics relative to general comorbidity measures in an obstetric population. This study aimed to externally validate this index and to examine the impact of including hospitalisation/delivery records only when estimating comorbidity prevalence and discriminative performance of the obstetric comorbidity index.
  
  
  METHODS
  Validation study.
  
  
  METHODS
  Alberta, Canada.
  
  
  METHODS
  Pregnant women who delivered a live or stillborn infant in hospital (n = 5995).
  
  
  METHODS
  Administrative databases were linked to create a population-based cohort. Comorbid conditions were identified from diagnoses for the delivery hospitalisation, all hospitalisations and all healthcare contacts (i.e. hospitalisations, emergency room visits and physician visits) that occurred during pregnancy and 3 months pre-conception. Logistic regression was used to test the discriminative performance of the comorbidity index.
  
  
  METHODS
  Maternal end-organ damage and extended length of stay for delivery.
  
  
  RESULTS
  Although prevalence estimates for comorbid conditions were consistently lower in delivery records and hospitalisation data than in data for all healthcare contacts, the discriminative performance of the comorbidity index was constant for maternal end-organ damage [all healthcare contacts area under the receiver operating characteristic curve (AUC) = 0.70; hospitalisation data AUC = 0.67; delivery data AUC = 0.65] and extended length of stay for delivery (all healthcare contacts AUC = 0.60; hospitalisation data AUC = 0.58; delivery data AUC = 0.58).
  
  
  CONCLUSIONS
  The obstetric comorbidity index shows similar performance characteristics in an external population and is a valid measure of comorbidity in an obstetric population. Furthermore, the discriminative performance of the comorbidity index was similar for comorbidities ascertained at the time of delivery, in hospitalisation data or through all healthcare contacts.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Metcalfe
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: L M
authors.initials: LM
authors.lastname: Lix
authors.affiliation: Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada.
authors.forename: J-A
authors.initials: JA
authors.lastname: Johnson
authors.affiliation: Department of Paediatrics, University of Calgary, Calgary, AB, Canada.|Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Currie
authors.affiliation: Department of Pathology and Laboratory Medicine, Saskatoon Health Region and College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: A W
authors.initials: AW
authors.lastname: Lyon
authors.affiliation: Department of Clinical Genetics, University of Calgary, Calgary, AB, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Bernier
authors.affiliation: Department of Paediatrics, University of Calgary, Calgary, AB, Canada.|Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
authors.forename: S C
authors.initials: SC
authors.lastname: Tough
mesh_terms: D000328:Adult; D019540:Area Under Curve; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D017063:Outcome Assessment, Health Care / Q000592:standards*; D011247:Pregnancy; D012720:Severity of Illness Index
keywords: Comorbidity; International Classification of Diseases; pregnancy; prevalence; validation