1. Independent Analysis FAIL PASS Initial Screen 77,148 18 174 76,956 25
Repeat Screen
174
76,956
Repeat Screen 25
149
Our independent analysis corrected for those errors in provider interpretation and excluded infants with insufficient pulse oximetry data leaving 77,148 infants. Following the AAP algorithm, we classified infants as passing, failing due to sat <90%, or having an indeterminate screen requiring repeat screening. We completed this for each repeat screen to determine the total number of positive and negative screens.
Non-Pass 16 9
Total Positive 34
Total Negative
77,114

2. Modifying the Algorithm
Initial Screen
77,148 18
Repeat Screen
174
76,956
Repeat Screen 25
149
We noted among the infants with failed screens due to sat <90%, including the true positive, all were identified on the initial screen. Eliminating the final repeat screen would not have missed any infants that are theoretically most likely to have significant disease.
Non-Pass 16 9
Total Positive 34
Total Negative
77,114

3. Modified Algorithm Total Positive 43 18 Non-Pass 25 Initial Screen
77,148 18
Repeat Screen
174
76,956
Non-Pass 25
149
And eliminating that screen would only add an additional 9 infants who would have required further evaluation.
Total Positive 43
Total Negative
77,105

4. Comparing Algorithms Sensitivity 14.3% False Positive Rate
Current AAP Algorithm
Modified Algorithm
Sensitivity
14.3%
False Positive Rate
1 in ~2500 births
(0.043%)
1 in ~2000 births
(0.054%)
When compared to the current algorithm, there was no change in the sensitivity of screening and though the false positive rate would increase slightly, it has minimal impact with only an additional 2-3 infants requiring additional evaluation each year.