Table 2

PROMPT training effectiveness (OR and associated 95% CI); main analysis and sensitivity analyses*

Across participating units†Across health system‡
Intention-to-treat‘As-implemented’‘As-implemented’
OR95% CIP valueOR95% CIP valueOR95% CIP value
Intervention effect
UnexposedRefRefRef
Exposed
 Complete-cases0.79(0.63 to 1.01)0.061.01(0.84 to 1.22)0.921.09(0.93 to 1.28)0.27
 Imputation 10.80(0.63 to 1.01)0.061.01(0.84 to 1.22)0.901.09(0.93 to 1.28)0.26
 Imputation 20.81(0.64 to 1.01)0.061.00(0.83 to 1.19)0.991.11(0.95 to 1.28)0.18
Adjustment factors
Time period
Control periodRefRefRef
Intervention period 1
 Complete-cases1.16(0.93 to 1.43)0.191.06(0.87 to 1.29)0.581.09(0.92 to 1.29)0.32
 Imputation 11.15(0.93 to 1.43)0.191.05(0.86 to 1.29)0.601.09(0.92 to 1.28)0.33
 Imputation 21.14(0.93 to 1.41)0.211.05(0.87 to 1.28)0.601.07(0.91 to 1.26)0.42
Intervention period 2
 Complete-cases1.34(1.03 to 1.74)0.031.13(0.91 to 1.40)0.261.18(0.99 to 1.40)0.06
 Imputation 11.34(1.03 to 1.73)0.031.13(0.91 to 1.39)0.281.18(0.99 to 1.40)0.07
 Imputation 21.35(1.05 to 1.73)0.021.15(0.94 to 1.41)0.171.18(1.00 to 1.39)0.05
Intervention period 3
 Complete-cases1.46(1.08 to 1.99)0.011.16(0.92 to 1.44)0.201.08(0.90 to 1.30)0.40
 Imputation 11.46(1.07 to 1.98)0.021.15(0.92 to 1.44)0.221.08(0.90 to 1.30)0.41
 Imputation 21.46(1.09 to 1.97)0.011.18(0.95 to 1.46)0.131.07(0.90 to 1.27)0.44
Follow-up period 1
 Complete-cases1.57(1.15 to 2.13)<0.011.23(0.96 to 1.58)0.091.17(0.96 to 1.41)0.11
 Imputation 11.56(1.15 to 2.12)<0.011.23(0.96 to 1.57)0.101.16(0.96 to 1.41)0.12
 Imputation 21.63(1.21 to 2.19)<0.011.32(1.04 to 1.67)0.021.19(1.00 to 1.43)0.05
Follow-up period 2
 Complete-cases1.53(1.12 to 2.07)<0.011.20(0.93 to 1.56)0.161.09(0.89 to 1.33)0.40
 Imputation 11.52(1.12 to 2.06)<0.011.23(0.96 to 1.57)0.101.09(0.89 to 1.32)0.41
 Imputation 21.50(1.12 to 2.02)<0.011.21(0.95 to 1.56)0.131.06(0.88 to 1.28)0.55
Pre-study maternity unit size
Small
 Complete-cases1.27(0.72 to 2.23)0.411.24(0.72 to 2.16)0.441.18(0.75 to 1.86)0.46
 Imputation 11.26(0.71 to 2.23)0.421.24(0.71 to 2.16)0.451.18(0.75 to 1.86)0.47
 Imputation 21.27(0.79 to 2.04)0.331.25(0.79, 1.97)0.341.21(0.83 to 1.77)0.32
MediumRefRefRef
Large
 Complete-cases1.28(0.78 to 2.10)0.331.27(0.78 to 2.06)0.331.29(0.90 to 1.84)0.16
 Imputation 11.27(0.77 to 2.10)0.341.27(0.78 to 2.06)0.341.29(0.90 to 1.84)0.17
 Imputation 21.26(0.83 to 1.89)0.271.25(0.84 to 1.85)0.271.27(0.95 to 1.70)0.10
Pre-study maternity Apgar score
Below national rate
 Complete-cases0.75(0.41 to 1.37)0.350.72(0.40 to 1.29)0.270.69(0.46 to 1.04)0.07
 Imputation 10.74(0.40 to 1.35)0.330.71(0.40 to 1.28)0.260.68(0.45 to 1.03)0.07
 Imputation 20.88(0.53 to 1.44)0.610.85(0.53 to 1.36)0.490.83(0.59 to 1.16)0.26
Similar to national rateRefRefRef
Above national rate
 Complete-cases2.17(1.31 to 3.58)<0.012.09(1.28 to 3.41)<0.011.91(1.32 to 2.77)<0.01
 Imputation 12.17(1.31 to 3.60)<0.012.10(1.28 to 3.43)<0.011.91(1.32 to 2.78)<0.01
 Imputation 22.03(1.33 to 3.09)<0.011.96(1.32 to 2.93)<0.011.82(1.34 to 2.48)<0.01
  • Intention-to-treat: Intervention periods defined according to randomisation schedule. ‘As-implemented’: Intervention periods defined according to actual start of first local intervention training session. Complete-cases: Analysis includes only births with assigned Apgar score considered (n=86 514 for the 12 units or n=123 077 for the 15 units). Imputation 1: All births included (n=87 204 for the 12 units or n=123 943 for the 15 units). Births with missing Apgar scores assigned to Apgar<75mins group. Imputation 2: All births included. Births with missing Apgar scores considered as Apgar<75mins. Babies with no Apgar score but recorded as admitted to a neonatal intensive care unit and/or received a form of resuscitation other than facial oxygen assigned to Apgar<75mins group; remaining babies with missing scores assigned to the Apgar≥75mins group.

  • *Mixed effects logistic regression (with random effects for clustering of births within unit) assessing intervention and adjusted for time trend, pre-study maternity unit size and status of pre-study prevalence rate of Apgar score<75mins.

  • †12 Scottish maternity units not exposed to the intervention prior to this study including two randomised units which declined to participate during the study period.

  • ‡All 15 Scottish maternity units with ≥900 births/year.