SURUSS in Perspective‡‡
Section snippets
Methods
SURUSS was based on 47,507 women recruited between September 1996 and April 2000 who attended 25 maternity centres (24 in the United Kingdom and one in Austria). Follow up was carried out to 31 May 2001. Outcomes were known for 96% of all pregnancies and ascertainment of Down’s Syndrome was probably complete through crosschecking with the National Down’s Syndrome Cytogenetic Register. There were 47,053 singleton pregnancies, including 101 with Down’s Syndrome. The number of Down’s Syndrome
Results
The most effective screening test was the Integrated test, with an estimated 85% detection rate for a 0.9% falsepositive rate—about one-fifth the number of false-positives that would arise using the first trimester Combined test or second trimester Quadruple test at the same detection rates (see Fig. 1). At an 85% detection rate, the false-positive rate for the Serum Integrated test was 3.9%, and 4.3% for the Combined test with the first trimester markers measured at 11 weeks. It was 6.2% for
Discussion
SURUSS provides, for the first time, a data set based on a single cohort of screened women, from which any combination of the specified screening markers within the first or second trimesters, or across both trimesters can be examined.
The main results of the SURUSS study were based on over 47,000 singleton pregnancies of which 101 had Down’s Syndrome, close to what we had aimed for in the protocol (50,000 pregnancies and 100 with Down’s Syndrome). SURUSS had the statistical power to yield
Conclusion
Our results show that, on the basis of efficacy, safety and cost, the Integrated test is the test of choice, confirming previous estimates based on combining the results from different studies.23 Adding other markers provided little benefit. If a nuchal translucency measurement was unavailable, the Serum Integrated test would be the next best screening method, with a better screening performance than any first or second trimester serum screening test. A multicentre demonstration project in
Acknowledgements
The SURUSS project was supported under the UK Health Technology Assessment research and development programme.
Declaration of interests
St Bartholomew’s and the Royal London School of Medicine and Dentistry together with the Foundation for Blood Research and Women and Infants Hospital (Providence, Rhode Island) hold a patent for unconjugated oestriol measurement as a marker for Down’s Syndrome screening. Professor Wald is a director of Logical Medical Systems, which produces alpha, a commercial interpretive software package for Down’s Syndrome screening using ultrasound and serum markers. He is also a director of Intema, which
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Republished with permission of British Journal of Obstetrics and Gynaecology and the authors from BJOG 111(6):521-53, 2004