Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy.
Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy.
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DOI：
10.1016/j.cgh.2014.05.011
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发表时间：
2015-10
影响因子：
12.6
通讯作者：
Wade, James B.
中科院分区：
文献类型：
--
作者：
Bajaj, Jasmohan S.;Heuman, Douglas M.;Sterling, Richard K.;Sanyal, Arun J.;Siddiqui, Muhammad;Matherly, Scott;Luketic, Velimir;Stravitz, R. Todd;Fuchs, Michael;Thacker, Leroy R.;Gilles, HoChong;White, Melanie B.;Unser, Ariel;Hovermale, James;Gavis, Edith;Noble, Nicole A.;Wade, James B.
隐性肝性脑病（CHE）的检测很困难，但床旁检测可以提高诊断率。我们旨在验证智能手机应用程序EncephalApp（Stroop App的简化版本）检测CHE的能力。我们评估了表面效度，重测信度和外部效度。肝硬化患者（n=167; 38%有明显HE [OHE];平均年龄，55岁;终末期肝脏疾病评分的平均模型，12）和对照组（n=114）分别给予纸笔认知测试（标准）沿着携带EncephalApp。EncephalApp具有关闭和打开状态;测量的结果为：关闭时间、打开时间、关闭时间+打开时间以及完成5次关闭和打开运行所需的运行次数。36名肝硬化患者接受了驾驶模拟测试，EncephalApp结果与结果相关。在一个亚组的患者中分析了重测信度。在经颈静脉肝内门体分流术放置前后，低钠血症纠正前后进行测试，以确定外部有效性。所有肝硬化患者在纸笔和EncephalApp测试中的表现都比对照组差。有肝硬化和OHE的患者比没有OHE的患者表现更差。设定了脑电依赖性EncephalApp临界值（小于或大于45岁）。>190秒的关闭时间+开启时间值识别出具有0.91的受试者操作特征（AUROC）值下的面积的所有CHE患者;对于在没有OHE的那些中诊断CHE的AUROC值为0.88。EncephalApp时间与驾驶模拟测试中的碰撞和非法转弯相关。重测信度高（类内系数，0.83）之间的30例患者重新测试1-3个月。10例患者在经颈静脉肝内门体分流术放置后33±7天重新测试，OffTime+OnTime显著增加（206 vs 255，P= 0.007）。7例患者在校正低钠血症（126±3至132±4 meq/L，P=.01）前后（间隔10±5天），OffTime+OnTime显著降低（242 vs 225，P=.03）。一个名为EncephalApp的智能手机应用程序具有良好的表面效度，重测信度和CHE诊断的外部效度。
Detection of covert hepatic encephalopathy (CHE) is difficult but point of care testing could increase rates of diagnosis. We aimed to validate the ability of the smartphone app EncephalApp, a streamlined version of Stroop App, to detect CHE. We evaluated face validity, test–retest reliability, and external validity. Patients with cirrhosis (n=167; 38% with overt HE [OHE]; mean age, 55 years; mean model for end-stage liver disease score, 12) and controls (n=114) were each given a paper and pencil cognitive battery (standard) along with EncephalApp. EncephalApp has Off and On states; results measured were: OffTime, OnTime, OffTime+OnTime, and number of runs required to complete 5 off and on runs. Thirty-six patients with cirrhosis underwent driving simulation tests, and EncephalApp results were correlated with results. Test–retest reliability was analyzed in a subgroup of patients. The test was performed before and after transjugular intra-hepatic portosystemic shunt placement, before and after correction for hyponatremia, to determine external validity. All patients with cirrhosis performed worse on paper and pencil and EncephalApp tests than controls. Patients with cirrhosis and OHE performed worse than those without OHE. Age-dependent EncephalApp cut-offs (younger or older than 45 years) were set. An OffTime+OnTime value of >190 seconds identified all patients with CHE with an area under the receiver operator characteristic (AUROC) value of 0.91; the AUROC value was 0.88 for diagnosis of CHE in those without OHE. EncephalApp times correlated with crashes and illegal turns in driving simulation tests. Test–retest reliability was high (intra-class coefficient, 0.83) among 30 patients retested 1–3 months apart. OffTime+OnTime increased significantly (206 vs 255, P=.007) among 10 patients retested 33±7 days after transjugular intra-hepatic portosystemic shunt placement. OffTime+OnTime decreased significantly (242 vs 225, P=.03) in 7 patients tested before and after correction for hyponatremia (126±3 to 132±4 meq/L, P=.01), 10±5 days apart. A smartphone app called EncephalApp has good face validity, test–retest reliability, and external validity for the diagnosis of CHE.
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影响因子：
29.4
作者：
Bajaj JS;Schubert CM;Heuman DM;Wade JB;Gibson DP;Topaz A;Saeian K;Hafeezullah M;Bell DE;Sterling RK;Stravitz RT;Luketic V;White MB;Sanyal AJ
通讯作者：
Sanyal AJ
影响因子：
29.4
作者：
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通讯作者：
Haeussinger, Dieter
影响因子：
1.3
作者：
Zhang, Long Jiang;Yang, Guifen;Qi, Ji
通讯作者：
Qi, Ji
影响因子：
13.5
作者：
Prasad, Srinivasa;Dhiman, Radha K.;Agarwal, Ritesh
通讯作者：
Agarwal, Ritesh
影响因子：
25.7
作者：
Ahluwalia, Vishwadeep;Wade, James B.;Bajaj, Jasmohan S.
通讯作者：
Bajaj, Jasmohan S.