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The aim of this study was to validate the ROP activity scale (ROP\u2010ActS) in a ROP screened cohort with protocol based collected data by evaluating the ability of the ROP\u2010Act scores to predict ROP treatment. In addition, we aimed to evaluate the scale\u2019s sensitivity characteristic of disease severity by studying association with gestational age (GA) in comparison with conventionally used ROP stage and zone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cohort of 535 preterm infants with 3324 ROP examinations with an end\u2010point of ROP treatment or end of screening in Gothenburg, Sweden, was included. Median GA was 28.1\u00a0weeks, 47.5% were girls, and 74 (13.8%) infants were treated for ROP. The validation was performed by estimating probabilities for ROP treatment, and by applying logistic and linear regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The original ROP\u2010ActS was overall well\u2010ordered with respect to ability to predict ROP treatment but could be improved by re\u2010ordering score 3 (zone II stage 1) and 5 (zone III stage 3) based on our clinical cohort data. The modified ROP\u2010ActS was superior to ROP stage and zone in the prediction analysis of ROP treatment. Modified ROP\u2010ActS was more strongly related to GA than currently used ROP stage, but not zone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the studied cohort, the modified ROP\u2010ActS could better predict ROP treatment compared to ROP stage and zone. Retinopathy of Prematurity Activity Scale (ROP\u2010ActS) had a superior sensitivity characteristic studied through association to GA than conventionally used ROP stage.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.14532","type":"journal-article","created":{"date-parts":[[2020,6,27]],"date-time":"2020-06-27T10:39:39Z","timestamp":1593254379000},"page":"201-206","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Validation of the Retinopathy of Prematurity Activity Scale (ROP\u2010ActS) using retrospective clinical data"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2224-3236","authenticated-orcid":false,"given":"Aldina","family":"Pivodic","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"},{"name":"Statistiska konsultgruppen Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4748-0446","authenticated-orcid":false,"given":"Staffan","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Mathematical Sciences Chalmers University of Technology Gothenburg Sweden"},{"name":"Institute of Biomedicine University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8013-7597","authenticated-orcid":false,"given":"Andreas","family":"Stahl","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University Medical Center Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7644-6410","authenticated-orcid":false,"given":"Lois E.H.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Boston Children\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9259-1244","authenticated-orcid":false,"given":"Ann","family":"Hellstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,26]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.121.12.1684"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.14206"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.12506"},{"key":"e_1_2_5_5_1","article-title":"New modifications of Swedish ROP guidelines based on 10\u2010year data from the SWEDROP register","author":"Holmstrom G","year":"2019","journal-title":"Br J Ophthalmol"},{"key":"e_1_2_5_6_1","first-page":"1217","article-title":"Vascularization of the human fetal retina: roles of vasculogenesis and angiogenesis","volume":"41","author":"Hughes S","year":"2000","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.123.7.991"},{"key":"e_1_2_5_8_1","unstructured":"The MegaDonnaMega trialRetrieved fromhttps:\/\/clinicaltrials.gov\/ct2\/show\/NCT03201588?term=NCT03201588&draw=2&rank=1"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-8-8"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2018.5984"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2017.4838"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31344-3"},{"key":"e_1_2_5_13_1","unstructured":"The FIREFLEYE trial. 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