Development and validation of a risk assessment model for predicting the failure of early medical abortions: A clinical prediction model study based on a systematic review and meta-analysis

Objective: As the first model in predicting the failure of early medical abortion (EMA) was inefficient, this study aims to develop and validate a risk assessment model for predicting the failure of EMAs more accurately in a clinical setting. Methods: The derivation cohort was obtained from a comprehensive systematic review and meta-analysis. The clinically significant risk factors were identified and combined with their corresponding odds ratios to establish a risk assessment model. The risk factors were assigned scores based on their respective weightings. The model’s performance was evaluated by an external validation cohort obtained from a tertiary hospital. The outcome was defined as the incidence of EMA failure. Results: A total of 126,420 patients who had undergone medical abortions were included in the systematic review and meta-analysis, and the pooled failure rate was 6.7%. The final risk factors consisted of gestational age, maternal age, parity, previous termination of pregnancy, marital status, type of residence, and differences between gestational age calculated using the last menstrual period and that measured via ultrasound. The risk factors were assigned scores based on their respective weightings, with a maximum score of 19. The clinical prediction model exhibited a good discrimination, as validated by external verification (402 patients) with an area under the curve of 0.857 (95% confidence interval 0.804–0.910). The optimal cutoff value was determined to be 13.5 points, yielding a sensitivity of 83.3% and specificity of 75.4%. Conclusion: This study effectively establishes a simple risk assessment model including seven routinely available clinical parameters for predicting EMA failure. In preliminary validation, this model demonstrates good performance in terms of predictive efficiency, accuracy, calibration, and clinical benefit. However, more research and validation are warranted for future application. Trial registration number: CRD42023485388.