\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{The diagnostic accuracy of the NICE risk-stratification algorithm in
predicting pre-eclampsia: a systematic review with meta-analysis}



\author[1]{James Morris}%
\author[1]{Siraj Abualnaja}%
\author[2]{Miriam Baumgarten}%
\affil[1]{University of Cambridge School of Clinical Medicine}%
\affil[2]{University of Cambridge Department of Obstetrics and Gynaecology}%


\vspace{-1em}



  
  \date{June 15, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
\textbf{Objectives:}~~Pre-eclampsia is a hypertensive disorder of
pregnancy which, left untreated, can cause significant foeto-maternal
morbidity. Accordingly, the National Institution for Health and Care
Excellence (NICE) recommends that high-risk women be prescribed daily
prophylaxis with 75-150mg aspirin from twelve weeks' gestation until
delivery. NICE stratifies risk using eleven maternal risk factors;
however, no secondary research has been published evaluating the
diagnostic accuracy of this algorithm. This systematic review and
meta-analysis evaluates the sensitivity and specificity of the NICE
risk-stratification algorithm in predicting pre-eclampsia in pregnant
women [?]16 years.~\textbf{Methods:}~Systematic searches were conducted
using PubMed, Cochrane Library and SCOPUS to identify relevant papers
with a CBEM Level of Evidence [?]4. A total of twenty eligible studies and
892,061 pregnancies were included in our analyses. The logit-transformed
sensitivities and specificities from each study were modelled as a
bivariate distribution with random effects in order to generate
maximum-likelihood estimates (MLEs) for the overall sensitivity and
specificity of the algorithm in predicting
pre-eclampsia.~\textbf{Results:~}MLEs for the NICE algorithm's
sensitivity and specificity were~44.4\% (95\% CI 33.7-55.5) and 88.3\%
(95\% CI 83.9-91.6), respectively. Significant heterogeneity was
exhibited between the sensitivities~~(I\textsuperscript{2}=99.8\%, 95\%
CI = 99.54-99.65) and specificities (I\textsuperscript{2}=99.88\%, 95\%
CI = 99.87-99.89) calculated by each of the included studies.
Consequently, there is a low degree of certainty in these
estimates.~\textbf{Conclusions:~}The NICE risk-stratification algorithm
performs remarkably poorly when used to predict pre-eclampsia in any of
three gestational categories. Clinicians should advise women that around
1 in 5 high-risk patients and 1 in 25 low-risk patients go on to develop
pre-eclampsia. However, future studies will likely alter the values of
these statistics and the confidence therein.~\textbf{Key
Words:~}Pre-eclampsia, High-risk Pregnancy, Sensitivity and Specificity,
Predictive Value of Tests, Clinical Decision Rules.%
\end{abstract}%



\sloppy




\selectlanguage{english}
\FloatBarrier
\end{document}

