{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T17:01:25Z","timestamp":1792429285541,"version":"4.5.0"},"reference-count":29,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,6,7]],"date-time":"2022-06-07T00:00:00Z","timestamp":1654560000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007735","name":"American Urogynecologic Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007735","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005930","name":"ASCRS Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005930","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop and validate a model to predict obstetric anal sphincter injuries (OASIS) using only information available at the time of admission for labour.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A clinical predictive model using a retrospective cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>A US health system containing one community and one tertiary hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Sample<\/jats:title><jats:p>A total of 22\u2009873 pregnancy episodes with in\u2010hospital delivery at or beyond 21\u2009weeks of gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty antepartum risk factors were identified as candidate variables, and a prediction model was built using logistic regression predicting OASIS versus no OASIS. Models were fit using the overall study population and separately using hospital\u2010specific cohorts. Bootstrapping was used for internal validation and external cross\u2010validation was performed between the two hospital cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Model performance was estimated using the bias\u2010corrected concordance index (c\u2010index), calibration plots and decision curves.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifteen risk factors were retained in the final model. Decreasing parity, previous caesarean birth and cardiovascular disease increased risk of OASIS, whereas tobacco use and black race decreased risk. The final model from the total study population had good discrimination (c\u2010index 0.77, 95% confidence interval [CI] 0.75\u20130.78) and was able to accurately predict risks between 0 and 35%, where average risk for OASIS was 3%. The site\u2010specific model fit using patients only from the tertiary hospital had c\u2010stat 0.74 (95% CI 0.72\u20130.77) on community hospital patients, and the community hospital model was 0.77 (95%CI 0.76\u20130.80) on the tertiary hospital patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>OASIS can be accurately predicted based on variables known at the time of admission for labour. These predictions could be useful for selectively implementing OASIS prevention strategies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17239","type":"journal-article","created":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T09:14:22Z","timestamp":1653642862000},"page":"2062-2069","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Risk of obstetric anal sphincter injuries at the time of admission for delivery: A clinical prediction model"],"prefix":"10.1111","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3534-7800","authenticated-orcid":false,"given":"Douglas","family":"Luchristt","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Rebecca","family":"Meekins","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Duke University Medical Center  Durham North Carolina USA"},{"name":"Department of Biostatistics &amp; Bioinformatics Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Congwen","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics &amp; Bioinformatics Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad","family":"Grotegut","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Wake Forest Baptist Health  Winston\u2010Salem NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazema Y.","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Duke University Medical Center  Durham North Carolina USA"},{"name":"Department of Biostatistics &amp; Bioinformatics Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke","family":"Alhanti","sequence":"additional","affiliation":[{"name":"Department of Biostatistics &amp; 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