Performance of the clinical assessment scale for autoimmune encephalitis in a pediatric autoimmune encephalitis cohort.
Performance of the clinical assessment scale for autoimmune encephalitis in a pediatric autoimmune encephalitis cohort.
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儿童自身免疫性脑炎队列中自身免疫性脑炎临床评估量表的表现
DOI：
10.3389/fimmu.2022.915352
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发表时间：
2022
影响因子：
7.3
通讯作者：
中科院分区：
文献类型：
--
作者：
自身免疫性脑炎临床评定量表(CASE)是一种新的用于评估自身免疫性脑炎(AE)严重程度的量表，在成人AE中显示出良好的效度和可靠性，但在儿童AE中的表现缺乏数据。这项研究的目的是评估病例在一组AE儿童中的可靠性和有效性。选择2017年1月1日至2021年10月31日到贵州省人民医院就诊的47例脑脊髓炎患儿为研究对象。这一病例和MRS评分是由两名儿科神经科医生通过审查卫生信息系统的详细医疗记录获得的。最后，分析了病例在这一儿童脑性脑病队列中的表现。结果表明，抗NMDA受体脑炎是儿童AE最常见的类型(61.70%)。最常见的临床表现为语言障碍(85.1%)、精神症状(80.9%)和运动障碍/肌张力障碍(78.7%)。该病例具有较好的条目信度和评价者间信度，总分的克朗巴赫α系数为0.825，组内相关系数为0.980。各条目的Cronbach‘s Alpha值在0.16到0.406之间；条目1和条目9分别具有最低和最高的Cronbach’s Alpha值。经皮尔逊相关分析，CASE和MRS总分之间的标准效度为0.459，表明标准效度为轻度到良好。曲线下面积为0.992(95%可信区间：0.974~1.00)。选择临界值14来确定患者是否需要进入ICU；该临界值的敏感度为100%，特异度为92%。EEG、MRI和抗体滴度的变化与AE的严重程度无关。选择病例评分截止值9来表示是否需要二线治疗。该病例在儿童AE中具有良好的信度和效度；但是，该病例的某些条目可能不适用于该人群。因此，有必要对AE儿童的病例进行深入研究。
The Clinical Assessment Scale for Autoimmune Encephalitis (CASE), a new scale used for rating the severity of autoimmune encephalitis (AE), has demonstrated good validity and reliability in adults with AE, but there is a shortage of data on its performance in children with AE. This study aimed to assess the reliability and validity of the CASE in a cohort of children with AE. Forty-seven pediatric inpatients with AE who visited Guizhou Provincial People’s Hospital between January 1, 2017, and October 31, 2021, were enrolled in the study. The CASE and mRS scores were obtained through a review of detailed medical records from the Health Information System by two pediatric neurologists. Finally, the performance of the CASE in this pediatric AE cohort was analyzed. The results showed that anti-NMDA receptor encephalitis was the most common (61.70%) type of AE in children. The most common clinical manifestations were language problems (85.1%), psychiatric symptoms (80.9%), and dyskinesia/dystonia (78.7%). The CASE had good item reliability and interevaluator reliability; the Cronbach’s alpha value of the total score was 0.825, and the intraclass correlation (ICC) was 0.980. The Cronbach’s alpha value by item ranged from 0.16 to 0.406; items 1 and 9 had the lowest and highest Cronbach’s alpha values, respectively. The criterion validity between CASE and mRS total scores, as quantified by Pearson correlation, was 0.459, indicating slight to good criterion validity. The area under the curve (AUC) was 0.992 (95% confidence interval: 0.974-1.00). A cutoff value of 14 was selected to determine whether a patient needed admission to the ICU; this cutoff had a sensitivity of 100% and a specificity of 92%. The changes in EEG, MRI, and antibody titers were not related to the severity of AE. A CASE score cutoff of 9 was selected to indicate whether second-line treatment would be needed. The CASE has good reliability and validity in children with AE; however, some items of the CASE may not apply to this population. Thus, an in-depth study of the CASE is needed in children with AE.
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