Reliability of adenoma detection rate is based on procedural volume
Reliability of adenoma detection rate is based on procedural volume
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DOI：
10.1016/j.gie.2012.10.023
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发表时间：
2013-03-01
影响因子：
7.7
通讯作者：
Jacobson, Brian C.
中科院分区：
文献类型：
--
作者：
Do, Albert;Weinberg, Janice;Jacobson, Brian C.
背景：腺瘤检出率（ADR）是结肠镜检查的一个广受推崇的质量指标。然而，目前还没有关于最小手术次数的指南，以确保可靠的ADR estimate.Objective：我们试图说明如何基于置信区间（CI）的方法可以建议ADR计算的最小数量，并提供一种合理的方法来比较ADR和依赖于有限手术次数时的平均腺瘤数量（MAP）。设计：数学建模和使用真实的世界临床输入。设置：学术医疗中心。患者：进行结肠镜检查的成年人。方法和主要结果测量：我们使用公式p +/- 1.96根[p（1 - p）/n]计算了不同样本量下15%-40%理论ADR的95% CI，其中p是ADR点估计值，n是手术次数。然后，我们比较了17名内镜医生的ADR和95% CI，以确定CI是否提供了重要的额外信息。我们还使用公式（x）+/- 1.96（sd/root n）计算MAP的95%CI，其中（x）+/- 1.96（sd/root n）是MAP点估计值，sd是每个程序检测到的腺瘤数量的标准差。尽管17名内镜医生中有10名的ADR低于该组的合并平均ADR 34%，但只有3名内镜医生的CI不包含34%。同样，而9内窥镜的MAP低于该组的合并平均MAP为0.66，只有4个CI未能包含0.66.Limitations：临床例子来自少数医生和patients.Conclusions：大样本量需要一个可靠的评估内窥镜的ADR。在计算ADR和MAP时，95% CI考虑了不确定性，更好地反映了内镜医师的表现。（Gastrointest Endosc 2013;77：376-80.）
Background: Adenoma detection rate (ADR) is a widely touted quality measure for colonoscopy. However, there are no guidelines for minimum numbers of procedures to include to ensure reliable ADR estimates.Objective: We sought to illustrate how a confidence interval (CI)-based approach can suggest minimum numbers for ADR calculations and provide a reasonable method for comparing ADRs and the mean number of adenomas per procedure (MAP) when relying on limited numbers of procedures.Design: Mathematical modeling and use of real world clinical inputs.Setting: Academic medical center.Patients: Adults presenting for screening colonoscopy.Methods and Main Outcome Measurements: We calculated 95% CIs for theoretical ADRs of 15% to 40%, with varying sample sizes, using the formula p +/- 1.96 root[p(1 - p)/n], where p is the ADR point estimate and n is the number of procedures. We then compared the ADRs and 95% CIs among 17 endoscopists to determine whether CIs offered important additional information. We also calculated MAPs with 95% CIs using the formula (x) over bar +/- 1.96(sd/root n), where (x) over bar is the MAP point estimate and sd is the standard deviation of the number of adenomas detected per procedure.Results: Large numbers of procedures (eg, 500) are needed to provide narrow CIs for typical ADR estimates. Although 10 of the 17 endoscopists had an ADR below the group's combined mean ADR of 34%, only 3 endoscopists had CIs failing to contain 34%. Likewise, whereas 9 endoscopists had MAPs below the group's combined mean MAP of 0.66, only 4 had CIs failing to contain 0.66.Limitations: Clinical examples come from small numbers of physicians and patients.Conclusions: Large sample sizes are required for a reliable assessment of an endoscopist's ADR. When calculating ADRs and MAPs, 95% CIs account for uncertainty and better reflect endoscopist performance. (Gastrointest Endosc 2013;77:376-80.)