External validation of a predictive scale for postpartum hemorrhage in the primary health care level in Algeria
Keywords:
Postpartum Hemorrhage; External Validation; primary health care; Predictive Models; Maternal Mortality; Risk FactorsAbstract
Introduction: Postpartum hemorrhage is the leading cause of preventable maternal mortality in Algeria. In primary health care, accurate risk stratification is fundamental to ensure timely referral to higher-complexity medical centers.
Objective: To evaluate the external validity and diagnostic accuracy of a local scale for the prediction of primary postpartum hemorrhage in Algeria.
Material and Methods: A diagnostic validation study with a prospective cohort design was conducted at the Taghit Polyclinic, Béchar, between 2024 and 2025. The sample included 17 cases and 51 controls (1:3). Construct validity was analyzed using Kendall’s Tau-b coefficient, while criterion validity was assessed by comparing the local scale against the California Maternal Quality Care Collaborative tool. Discrimination was evaluated using the area under the curve, calibration through the Hosmer-Lemeshow test, and agreement using Cohen’s Kappa index.
Results: The local scale demonstrated superior discrimination with an area under the curve of 0.86 (95% Confidence Interval: 0.82–0.90) and an optimal calibration fit (p = 0.58). It achieved a sensitivity of 88.2% and a specificity of 82.4%, significantly outperforming the international tool, which showed a specificity of only 45.1%. Concordance analysis revealed that the local scale correctly reclassified 23.5% of the sample that the international model had underestimated.
Conclusions: In the studied sample, the local scale demonstrated higher discrimination and calibration indicators than those given in international reference models, achieving greater accuracy for the regional clinical profile.
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