The influence of loss to follow-up in autism screening research: Taking stock and moving forward.
The influence of loss to follow-up in autism screening research: Taking stock and moving forward.
复制标题
自闭症筛查研究中失访对随访的影响：盘点并前进。
DOI：
10.1111/jcpp.13867
复制
发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Wetherby,AmyM
中科院分区：
文献类型：
--
作者：
Sheldrick,RChristopher;Hooker,JessicaL;Carter,AliceS;Feinberg,Emily;Croen,LisaA;Kuhn,Jocelyn;Slate,Elizabeth;Wetherby,AmyM
背景如何最好地改善自闭症谱系障碍（ASD）的早期发现是一个存在重大争议的话题。一些人认为通用自闭症谱系障碍筛查仪非常准确，而另一些人则认为这一说法的证据不足。与此相关的是，对于筛查对于做出评估和治疗转诊决定的最佳作用还没有明确的共识。已发表的筛查研究可以有意义地告知这些问题，但只有通过仔细考虑未完成诊断随访的儿童。方法我们开发了两个模拟模型，重新分析 Robins 等人对 M-CHAT-R/F 进行的大规模验证研究的结果。 (2014,儿科,133, 37)。模型#1 重新分析了六种情况下的筛查准确性，每种情况都反映了有关失访的不同假设。模型#2 以此为基础，通过仔细检查多步骤检测过程中每个点的差异磨损。结果不同场景的敏感性估计范围为 40% 到 94%，这表明准确性的估计取决于有关失访儿童诊断状态的假设。在一系列看似合理的假设中，数据还表明，未诊断自闭症谱系障碍的儿童可能比没有自闭症谱系障碍的儿童更有可能完成随访，这凸显了临床医生和护理人员在检测过程中的作用。结论使用模拟模型作为定量方法来检查筛查研究中的潜在偏差，分析表明，自闭症谱系障碍筛查工具可能不如通常报道的准确。模型还证明了检测过程中每个步骤的至关重要性，包括确定儿童是否应该完成额外评估的步骤。我们的结论是，家长和临床医生关于随访的决策对检测的贡献可能比人们普遍认为的更大。
BackgroundHow best to improve the early detection of autism spectrum disorder (ASD) is the subject of significant controversy. Some argue that universal ASD screeners are highly accurate, whereas others argue that evidence for this claim is insufficient. Relatedly, there is no clear consensus as to the optimal role of screening for making referral decisions for evaluation and treatment. Published screening research can meaningfully inform these questions—but only through careful consideration of children who do not complete diagnostic follow‐up.MethodsWe developed two simulation models that re‐analyze the results of a large‐scale validation study of the M‐CHAT‐R/F by Robins et al. (2014,Pediatrics,133, 37). Model #1 re‐analyzes screener accuracy across six scenarios, each reflecting different assumptions regarding loss to follow‐up. Model #2 builds on this by closely examining differential attrition at each point of the multi‐step detection process.ResultsEstimates of sensitivity ranged from 40% to 94% across scenarios, demonstrating that estimates of accuracy depend on assumptions regarding the diagnostic status of children who were lost to follow‐up. Across a range of plausible assumptions, data also suggest that children with undiagnosed ASD may be more likely to complete follow‐up than children without ASD, highlighting the role of clinicians and caregivers in the detection process.ConclusionsUsing simulation modeling as a quantitative method to examine potential bias in screening studies, analyses suggest that ASD screening tools may be less accurate than is often reported. Models also demonstrate the critical importance of every step in a detection process—including steps that determine whether children should complete an additional evaluation. We conclude that parent and clinician decision‐making regarding follow‐up may contribute more to detection than is widely assumed.