Anticipating conversion to hysterectomy in women counseled for myomectomy: temporal validation of the EFFAH score at a Ghanaian district hospital

The EFFAH eight-item bedside score predicts hysterectomy after myomectomy counseling in a later cohort at a Ghana district hospital, with C-statistics 0.73–0.76.

• Why it matters: Consent for myomectomy requires estimating preoperative hysterectomy probability, yet no published tool had been validated in sub-Saharan Africa to guide counseling and triage.
• What they did: In a retrospective temporal external validation, 392 development records (2013–2014) and 800 validation records (2017–2019) from Catholic Hospital, Battor, were used to assess discrimination, calibration, and net benefit.
• The result: Hysterectomy occurred in 21.1% (validation), the intercept-only update aligned predicted and observed risk (observed-to-expected 0.69; calibration slope 0.83), and AutoScore did not outperform (difference 0.01).