Multi-site performance of the telemedicine retinopathy of prematurity severity score (tROP-SS).

OBJECTIVE This study aims to evaluate the performance of the telemedicine retinopathy of prematurity severity score (tROP-SS) across all 14 NICUs in the TELEROP cohort against the modified ROP activity score (mROP-ActS). DESIGN Retrospective cohort study. SUBJECTS The study included 2037 neonates who underwent ROP screening in 14 NICUs via the TELEROP telemedicine network from November 2017 to January 2025. METHODS We compared the robustness of tROP-SS and mROP-Act systems across all exams. MAIN OUTCOME MEASURES The primary outcomes studied were the ability to return a score in cases responding to treatment, correlation between the two scores and the ability to assess disease directionality. RESULTS The study analysed 192 704 photos from 11 368 ROP exams on 2037 patients. tROP-SS generated scores for 100% of exams, demonstrating significant improvements over mROP-ActS, which scored only 92.3% of all exams (p = 0.0136). All patients who met treatment criteria received treatment in both eyes. Among high-risk and treatment warranted (TW) patients, 100.0% exams had a valid tROP-SS exam compared with only 72.73% and 45.27% with a valid mROP-ActS. Only 20.9% high-risk or TW patients had a valid mROP-ActS across all their exams. Incremental increases in tROP-SS were more strongly related to worsening of disease: OR (95% CI) - 3.37 (2.51-4.53) versus 1.57 (1.46-1.69), both p < 0.0001. tROP-SS also demonstrated improved granularity and accuracy in categorizing patients that would ultimately require treatment (AUC: 0.991 vs. 0.825). CONCLUSIONS tROP-SS was retrospectively evaluated across 14 NICUs, proving to be a more robust scoring system compared to mROP-ActS. The findings support continued use of tROP-SS, supplemented by standard screening protocols to ensure no cases of treatment-warranted ROP are missed. Future research may focus on integrating additional parameters to enhance predictive models to improve early ROP detection.