title: Breastfeeding Assessment Score: Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Previous studies have revealed conflicting results for the Breastfeeding Assessment Score (BAS) in predicting early breastfeeding cessation. Our objective was to externally validate the BAS and provide summary accuracy estimates for this clinical prediction model.
  
  
  METHODS
  We used the original data from a prospective cohort study. Additional studies were identified by searching electronic databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane) from 2002 to 2013 and contacting research groups that had derived or validated the BAS. Prospective cohort studies were eligible if the BAS was computed at baseline and mothers were followed up for breastfeeding cessation. Two physicians extracted relevant information and independently assessed the methodological quality for the included studies.
  
  
  RESULTS
  In the external validation cohort, 22 of 424 mothers (5.2%) discontinued breastfeeding within 14 days of infant age. The BAS predicted early breastfeeding cessation with an area under the curve of 0.70 (95% confidence interval [CI]: 0.65 to 0.74) and inadequate calibration. When restricting the meta-analysis to 3169 mother-infant pairs enrolled in 4 higher-quality studies, a BAS value <8 predicted early cessation with 0.80 sensitivity (95% CI: 0.69 to 0.91) and 0.51 specificity (95% CI: 0.32 to 0.70) summary estimates.
  
  
  CONCLUSIONS
  Substantial between-study heterogeneity limited the interpretation of summary accuracy estimates. The BAS predicts early breastfeeding cessation with moderate accuracy, although local recalibration is advised before implementation. Further study is warranted to determine whether the BAS can help pediatricians in identifying mother-infant pairs that may benefit from more extensive breastfeeding assessment and support.
authors: University Hospital, Clermont-Ferrand, France;
authors: Tatiana
authors: T
authors: Raskovalova
authors: Children's Mercy, Kansas City, Missouri;
authors: Susan L
authors: SL
authors: Teasley
authors: Association Française de Pédiatrie Ambulatoire, Chambéry, France;
authors: Nathalie
authors: N
authors: Gelbert-Baudino
authors: Università degli Studi, Milano, Italy;
authors: Paola Agnese
authors: PA
authors: Mauri
authors: Association Française de Pédiatrie Ambulatoire, Chambéry, France;
authors: Camille
authors: C
authors: Schelstraete
authors: University Hospital, Grenoble, France; and.
authors: Maximillien
authors: M
authors: Massoutier
authors: University Hospital, Clermont-Ferrand, France;
authors: Marc
authors: M
authors: Berger
authors: University Hospital, Grenoble, France; and Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble, Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique, Université Joseph Fourier-Grenoble 1, Grenoble, France.
authors: Patrice
authors: P
authors: François
authors: University Hospital, Grenoble, France; and Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble, Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique, Université Joseph Fourier-Grenoble 1, Grenoble, France jlabarere@chu-grenoble.fr.
authors: José
authors: J
authors: Labarère
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055815:Young Adult
keywords: breastfeeding; clinical prediction model; meta-analysis; validation studies; weaning