Designing verbal autopsy studies
Designing verbal autopsy studies
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DOI：
10.1186/1478-7954-8-19
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发表时间：
2010-01-01
影响因子：
3.3
通讯作者：
Shibuya, Kenji
中科院分区：
文献类型：
--
作者：
King, Gary;Lu, Ying;Shibuya, Kenji
背景：在世界上绝大多数没有高质量医学死亡登记的地区，死因解剖分析被广泛用于估计死因特异性死亡率（CSMR）。口头解剖——对即将死去的人的照料者进行调查访谈——取代了医学检查或身体解剖，这是不可行的或在文化上被禁止的。方法和发现：我们在King和Lu（2008）提出的新方法的基础上，引入了可以改进csmr自动化、数据派生估计设计的方法、模拟和解释。我们的结果为选择症状问题和样本大小提供建议，这比现有的做法更容易满足。例如，大多数先前的努力都致力于寻找具有高灵敏度和特异性的症状，但在多种死亡原因中很少成功。相比之下，我们的方法使这种搜索无关紧要，因为它可以产生无偏估计，即使症状具有非常低的敏感性和特异性。此外，新方法优化了调查问题，照顾者可以很容易地回答，而不是医生会问自己的问题。我们还提供了一种自动化的方法来剔除有偏见的症状问题，并就如何选择死亡原因的数量、提出的症状问题和收集的观察结果等提供建议。结论：根据本文提供的建议，研究人员应该能够设计口头尸检调查并进行分析，大大减少统计偏差和研究成本。
Background: Verbal autopsy analyses are widely used for estimating cause-specific mortality rates (CSMR) in the vast majority of the world without high-quality medical death registration. Verbal autopsies - survey interviews with the caretakers of imminent decedents - stand in for medical examinations or physical autopsies, which are infeasible or culturally prohibited.Methods and Findings: We introduce methods, simulations, and interpretations that can improve the design of automated, data-derived estimates of CSMRs, building on a new approach by King and Lu (2008). Our results generate advice for choosing symptom questions and sample sizes that is easier to satisfy than existing practices. For example, most prior effort has been devoted to searching for symptoms with high sensitivity and specificity, which has rarely if ever succeeded with multiple causes of death. In contrast, our approach makes this search irrelevant because it can produce unbiased estimates even with symptoms that have very low sensitivity and specificity. In addition, the new method is optimized for survey questions caretakers can easily answer rather than questions physicians would ask themselves. We also offer an automated method of weeding out biased symptom questions and advice on how to choose the number of causes of death, symptom questions to ask, and observations to collect, among others.Conclusions: With the advice offered here, researchers should be able to design verbal autopsy surveys and conduct analyses with greatly reduced statistical biases and research costs.