Abstract：
BACKGROUND: Many 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.
OBJECTIVE: To determine if clinicians could use NIC-PREDICT accurately, and if their perceptions of infant outcomes improved after its release in 2021.
METHODS: Midwives, 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.
RESULTS: A 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).
CONCLUSIONS: Most 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.
OBJECTIVE: To determine if clinicians could use NIC-PREDICT accurately, and if their perceptions of infant outcomes improved after its release in 2021.
METHODS: Midwives, 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.
RESULTS: A 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).
CONCLUSIONS: Most 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.
摘要：
背景：许多临床医生高估了极早产婴儿的死亡率和致残率。我们开发了一种数字工具（“NIC-PREDICT”），可以预测妊娠23-27周出生的婴儿有或没有严重残疾的婴儿的死亡率和生存率。
目的：为了确定临床医生是否可以准确使用NIC-PREDICT，以及他们对婴儿结局的看法在2021年发布后是否有所改善。
方法：助产士，护士,产科医生,在维多利亚州三级和非三级医院工作的新生儿科医师和儿科医生被要求使用NIC-PREDICT来估计三个相互排斥的结局:(i)死亡率;(ii)无重大残疾生存率;(iii)在6种不同的情况下,活出生婴儿在出生后接受以生存为重点的护理的重大残疾生存率.确定了完成调查的比例（对所有六种情况做出了回应）以及能够为所有情况提供100％准确结果的比例。将三个结果的估计值与真实比率进行比较。
结果：共有85名临床医生回答：70名（82％）完成了调查，总体准确率为76%。总的来说,对死亡率的预测是准确的(与真实值的平均差0.7%(95%置信区间(CI)-0.7，2.1)P=0.33)，对无严重残疾的生存率的预测也是如此(平均差-0.7(95%CI-3.0,1.7)P=0.58).然而,严重残疾的生存率被高估4.9%((95%CI1.7,8.0)P=0.003).
结论：大多数有反应的围产期临床医生正确使用NIC-PREDICT来估计接受重症监护的极度早产婴儿的预期结局。对严重残疾患者的生存过度悲观仍然是一个持续关注的问题。
目的：为了确定临床医生是否可以准确使用NIC-PREDICT，以及他们对婴儿结局的看法在2021年发布后是否有所改善。
方法：助产士，护士,产科医生,在维多利亚州三级和非三级医院工作的新生儿科医师和儿科医生被要求使用NIC-PREDICT来估计三个相互排斥的结局:(i)死亡率;(ii)无重大残疾生存率;(iii)在6种不同的情况下,活出生婴儿在出生后接受以生存为重点的护理的重大残疾生存率.确定了完成调查的比例（对所有六种情况做出了回应）以及能够为所有情况提供100％准确结果的比例。将三个结果的估计值与真实比率进行比较。
结果：共有85名临床医生回答：70名（82％）完成了调查，总体准确率为76%。总的来说,对死亡率的预测是准确的(与真实值的平均差0.7%(95%置信区间(CI)-0.7，2.1)P=0.33)，对无严重残疾的生存率的预测也是如此(平均差-0.7(95%CI-3.0,1.7)P=0.58).然而,严重残疾的生存率被高估4.9%((95%CI1.7,8.0)P=0.003).
结论：大多数有反应的围产期临床医生正确使用NIC-PREDICT来估计接受重症监护的极度早产婴儿的预期结局。对严重残疾患者的生存过度悲观仍然是一个持续关注的问题。
