PREP Models app for iPhone and iPad

The PREP App is a FREE risk prediction tool for healthcare professionals managing mothers with early onset pre-eclampsia in secondary and tertiary care settings. The App provides a percentage risk of getting at least one of the following maternal complications:
- Maternal death
- Pulmonary oedema
- Intubation
- Postpartum haemorrhage
- Hepatic dysfunction
- Hepatic haematoma
- Hepatic rupture
- Glasgow Coma Score greater than 13
- Stroke
- Cortical blindness
- Reversible Ischaemic Neurologic Deficit (RIND)
- Retinal detachment
- Acute renal insufficiency
- Dialysis
- Blood transfusion
- Positive ionotropic support
- Myocardial ischaemia or infarction
- less than 50% oxygen requirement for less than 1hour
The App was developed in a prospective, multicentre, observational cohort involving secondary and tertiary care obstetric patients in England and Wales, and validated in a multinational cohort (PIERS) and in another cohort from the Netherlands (PETRA).

FEATURES:
* Offline capability - this means the calculator works even where there is no mobile/wireless reception, for example in all clinical settings and even in reception black spots.
* All variables are routine tests and assessments, which are quick and easy to obtain at the time of diagnosis of pre-eclampsia

POTENTIAL AREAS OF USE:
* There is an increased focus on risk prediction in obstetric medicine.
* The PREP app has a potential role as a triaging tool by providing complication risk estimates that can help set the scene to identify high-risk mothers for in-utero transfer to tertiary care unit. It can also determine use of corticosteroids depending on the predicted probability of complications. It could also contribute to the consent process and shared decision-making with patients and aid resource planning.
* A simple tool that should be used together with clinical judgement and in the context of current clinical care pathways.
*The PREP models can be used to obtain predictions of adverse maternal outcome risk, including early preterm delivery, by 48 hours (PREP-S) and by discharge (PREP-L), in women with early onset pre-eclampsia in the context of current care.
*The model in the App is designed to predict only the complications listed together, and cannot be used to predict individual complications.
BACKGROUND:
* Developed by researchers from the Womens’ Health Research Unit at Queen Mary University of London, utilizing funding provided by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Programme
* The work was published in the BMC Medicine journal in 2017 https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0827-3 ;
* A large scale study. Women with confirmed early onset pre-eclampsia were recruited from 53 maternity units in the UK to a large prospective cohort study (PREP-946 women) for development of prognostic models for the overall risk of experiencing a complication using logistic regression (PREP-L), and for predicting the time to adverse maternal outcome using a survival model (PREP-S). External validation of the models were carried out in a multinational cohort (PIERS-634 women) and another cohort from the Netherlands (PETRA-216 women).

DISCLAIMER
The PREP App should be used in the context of current clinical care pathways, and not considered in isolation. The model in the App is designed to predict only the complications listed together, and cannot be used to predict individual complications.
The App was developed by Pocket App and the intellectual property behind its development belong to Queen Mary University of London.

We hope this software tool proves to be a useful tool in triaging high risk women with early onset pre-eclampsia.