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Objective <p>To develop an organizational framework that examines the individual contributions of modifiable clinical interventions and non-modifiable physiologic variables on the fluctuating rate of intraventricular hemorrhage (grades 3/4) or death&lt;4 days over time.</p> Study design <p>We developed the <Emphasis Type="ItalicUnderline">F</Emphasis><i>requency-</i><Emphasis Type="ItalicUnderline">A</Emphasis><i>djusted-</i><Emphasis Type="ItalicUnderline">R</Emphasis><i>isk-difference-versus-</i><Emphasis Type="ItalicUnderline">OUT</Emphasis><i>come</i> (<i>FAR-Out</i>) approach to examine risk-differences and risk-frequencies during defined study epochs. We used <i>FAR-Out</i> to study changes in sIVH/death&lt;4 d rates after implementing a set of improved-practice guidelines in a preterm population (23<sup>0/7</sup>–27<sup>6/7</sup> weeks, <i>n</i> = 537).</p> Results <p>Epoch-to-epoch variations in <i>FAR-Out</i> Risk Scores track closely (Pearson’s <i>r</i> = 0.974) with epoch-to-epoch variations in sIVH/death&lt;4 d rates. Post-implementation changes in sIVH/death &lt;4 d rates were mostly associated with fluctuations in individual non-modifiable risks (immaturity/illness severity) rather than with changes in adherence to the guidelines’ modifiable practices.</p> Conclusion <p>Close correlation between <i>FAR-Out</i> Risk Scores and sIVH/death &lt; 4 d rates supports the <i>FAR-Out</i> approach’s potential usefulness in examining the relative influence of individual risk factors on the incidence of sIVH/death &lt;4 d.</p>

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A FAR-Out approach for evaluating the impact of clinical practice changes on severe intracranial hemorrhage in preterm infants

  • 期刊论文

  • 发表日期：

    2026年1月19日

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  • Ronald I. Clyman,
  • Nancy K. Hills

摘要

Objective

To develop an organizational framework that examines the individual contributions of modifiable clinical interventions and non-modifiable physiologic variables on the fluctuating rate of intraventricular hemorrhage (grades 3/4) or death<4 days over time.

Study design

We developed the Frequency-Adjusted-Risk-difference-versus-OUTcome (FAR-Out) approach to examine risk-differences and risk-frequencies during defined study epochs. We used FAR-Out to study changes in sIVH/death<4 d rates after implementing a set of improved-practice guidelines in a preterm population (230/7–276/7 weeks, n = 537).

Results

Epoch-to-epoch variations in FAR-Out Risk Scores track closely (Pearson’s r = 0.974) with epoch-to-epoch variations in sIVH/death<4 d rates. Post-implementation changes in sIVH/death <4 d rates were mostly associated with fluctuations in individual non-modifiable risks (immaturity/illness severity) rather than with changes in adherence to the guidelines’ modifiable practices.

Conclusion

Close correlation between FAR-Out Risk Scores and sIVH/death < 4 d rates supports the FAR-Out approach’s potential usefulness in examining the relative influence of individual risk factors on the incidence of sIVH/death <4 d.