External validation of IASP diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria
External validation of IASP diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria
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DOI：
10.1016/s0304-3959(99)00011-1
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发表时间：
1999-05-01
期刊：
影响因子：
7.4
通讯作者：
Stanton-Hicks, M
中科院分区：
文献类型：
--
作者：
Bruehl, S;Harden, RN;Stanton-Hicks, M
我们的研究联盟最近的工作已经提出了关于复杂区域疼痛综合征（CRPS）的当前IASP标准的内部有效性问题，这表明灵敏度和特异性不足的问题。当前的研究探讨了这些IASP CRPS标准的外部有效性，研究医生对117名符合IASP CRPS标准的患者和43名患有神经性疼痛且已确定非CRPS病因的患者进行了CRPS体征和症状的标准化评估（如糖尿病性神经病变、疱疹后神经痛），采用多元判别函数分析检验IASP诊断标准和决策规则的能力，以及对这些标准提出的研究修改，以区分CRPS患者和经历非CRPS神经性疼痛的患者。目前的IASP标准和决策规则（例如，水肿的体征或症状，或颜色变化或出汗变化满足标准3）在组间差异显著（P < 0.001）。然而，尽管敏感性很高（0.98），特异性很差（0.36），CRPS的阳性诊断可能只有40%的病例是正确的。基于经验的研究修改的标准，这是更全面的，需要存在的迹象和症状，也进行了测试。这些修改后的标准也能够显著区分CRPS和非CRPS组（P < 0.001）。决策规则要求至少两个体征类别和四个症状类别为阳性，优化了诊断效率，CRPS的诊断可能在高达84%的病例中准确，非CRPS神经性疼痛的诊断可能在高达88%的病例中准确。这些结果表明，目前的IASP标准CRPS的特异性不足，并可能导致过度诊断。对这些标准的拟议修改大大提高了其外部效度，值得进一步评价。(C)1999年国际疼痛研究协会。出版社：Elsevier Science B.V.
Recent work in our research consortium has raised internal validity concerns regarding the current IASP criteria for Complex Regional Pain Syndrome (CRPS), suggesting problems with inadequate sensitivity and specificity. The current study explored the external validity of these IASP criteria for CRPS, A standardized evaluation of signs and symptoms of CRPS was conducted by study physicians in 117 patients meeting IASP criteria for CRPS, and 43 patients experiencing neuropathic pain with established non-CRPS etiology (e.g. diabetic neuropathy, post-herpetic neuralgia), Multiple discriminant function analyses were used to test the ability of the IASP diagnostic criteria and decision rules, as well as proposed research modifications of these criteria, to discriminate between CRPS patients and those experiencing non-CRPS neuropathic pain. Current IASP criteria and decision rules (e.g, signs or symptoms of edema, or color changes or sweating changes satisfy criterion 3) discriminated significantly between groups (P < 0.001). However, although sensitivity was quite high (0.98), specificity was poor (0.36), and a positive diagnosis of CRPS was likely to be correct in as few as 40% of cases. Empirically-based research modifications to the criteria, which are more comprehensive and require presence of signs and symptoms, were also tested. These modified criteria were also able to discriminate significantly, between the CRPS and non-CRPS groups (P < 0.001). A decision rule, requiring at least two sign categories and four symptom categories to be positive optimized diagnostic efficiency, with a diagnosis of CRPS likely to be accurate in up to 84% of cases, and a diagnosis of non-CRPS neuropathic pain likely to be accurate in up to 88% of cases. These results indicate that the current IASP criteria for CRPS have inadequate specificity and are likely to lead to overdiagnosis. Proposed modifications to these criteria substantially improve their external validity and merit further evaluation. (C) 1999 International Association for the Study of Pain. Published by Elsevier Science B.V.