Classification methods for the identification of 'case' in epidemiological diagnosis of asthma
Classification methods for the identification of 'case' in epidemiological diagnosis of asthma
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DOI：
10.1023/a:1010987521885
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发表时间：
2001-01-01
影响因子：
13.6
通讯作者：
Marinoni, A
中科院分区：
文献类型：
--
作者：
Grassi, M;Villani, S;Marinoni, A
在流行病学研究中，哮喘“病例”的确定是一个有争议的问题。本研究旨在使用统计决策规则对哮喘受试者进行分类，该规则最大限度地降低了临床医生诊断的错误分类率。该规则是由流行病学研究中容易观察到的预测因素（哮喘样问题，生理测试）的组合定义的，而不一定包括专家医生的临床意见。从欧洲共同体呼吸健康调查（ECRHS）的三个意大利中心的1103例受试者的汇总数据中，获得了共识后临床医生对哮喘的诊断，并从18个潜在候选者中选择了7个预测因子（特异性范围为64%至99%，但敏感性范围为22%至62%）。用树结构分类器技术（分类和回归树，CART）、经典判别分析（Fisher线性判别函数，LDF）和神经网络方法（多层感知器，MLP模型）处理该数据集。结果表明，修改的“分类树”提供了一个更有用的决策规则，灵敏度（93%）和特异性（85%），比LDF或MLP。决策树很容易从临床角度解释，并使用七个预测因子中的五个（按降序排列：曾患哮喘、当前哮喘、呼吸短促、特应性和喘息和呼吸困难）。研究结果似乎表明，相对于以前的流行病学研究相当成功，并等待重复在其他ECHRS人群。
The identification of the asthmatic 'case' in epidemiological research is a controversial issue. This study was aimed at classifying asthmatic subjects using a statistical decision rule that minimised the misclassification rate with respect to the clinicians' diagnosis. The rule was defined by a combination of predictors that are easily observed in epidemiological studies (asthma-like questions, physiological tests) without necessarily including the clinical opinion of expert physicians. From pooled data on 1103 subjects at the three Italian centres of the European Community Respiratory Health Survey (ECRHS) a post-consensus clinicians' diagnosis of asthma was obtained, and seven predictors were selected from among 18 potential candidates (specificity ranged from 64 to 99%, but sensitivity ranged from 22 to 62%). This data set was processed with tree-structured classifier techniques (the Classification And Regression Trees, CART), classical discriminant analysis (Fisher's Linear Discriminant Function, LDF), and the neural network method (Multi-Layer Perceptron, MLP model). The results suggest that modifications of the 'classification tree' provide a more useful decision rule, sensitive (93%) and specific (85%), than either LDF or MLP. The decision tree is readily interpretable from a clinical perspective and uses five out of the seven predictors (in descending hierarchical order: ever had asthma, current asthma, shortness of breath, atopy and wheezing and breathless). The findings seem to indicate a considerable success with respect to previous epidemiological studies and await repetition in other ECHRS populations.