Assessment of strategies for identifying diagnosed cases of systemic lupus erythematosus through self-report
Assessment of strategies for identifying diagnosed cases of systemic lupus erythematosus through self-report
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DOI：
10.1191/0961203303lu460oa
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发表时间：
2003-01-01
期刊：
影响因子：
2.6
通讯作者：
Rosenberg, L
中科院分区：
文献类型：
--
作者：
McAlindon, TE;Formica, M;Rosenberg, L
这项工作的目的是评估在大型流行病学研究中通过自我报告的关于SLE诊断、症状和药物的信息来识别潜在系统性红斑狼疮（SLE）病例的最佳方法，并调查直接发送给参与者医生的标准检查表的效用。我们使用的数据收集于1997年从53322名参与者的研究，非洲裔美国妇女，黑人妇女的健康研究，包括狼疮筛查问卷（LSQ）和有关SLE诊断和药物治疗的问题。我们通过发送给参与者医生的医疗记录和标准检查表确认了自我报告的SLE。在我们收到医疗记录和/或标准检查表的患者中，我们比较了使用自我报告的SLE诊断，LSQ评分和药物使用组合的几种算法的预测值和漏诊病例比例与自我报告的SLE诊断单独。我们获得了251名报告SLE的患者的医生检查表或病历，其中212人（84%）符合ACR明确或可能SLE的标准，或患有临床狼疮（病历中记录的SLE诊断加上适当的药物使用）。使用LSQ评分或药物使用，以及自我报告SLE倾向于降低假阳性率，但也降低了确定的真实病例的比例。受试者医生完成的ACR标准检查表记录的标准多于医疗记录。总之，在同意病历审查的参与者中，使用有关狼疮症状和药物的问题的SLE预测算法为检测病例提供了比自我报告的诊断略高的预测值，但以病例检测为代价。SLE病例确认策略可以通过使用直接发送给参与者医生的标准检查表来补充。
The objective of this work was to assess the optimal way to identify potential systemic lupus erythematosus (SLE) cases in large epidemiologic studies through self-reported information about diagnosis of SLE, symptoms and medications, and to investigate the utility of a criteria checklist sent directly to participants' physicians. We used data collected in 1997 from 53322 participants in a study of African-American women, the Black Women's Health Study, including a lupus screening questionnaire(LSQ) and questions about SLE diagnosis and medications. We confirmed self-reported SLE through medical records and criteria checklists sent to participants' physicians. Among those for whom we received medical records and/or criteria checklists, we compared the predictive value and proportion of missed cases of several algorithms using combinations of self-reported SLE diagnosis, LSQ score and medication use to self-reported SLE diagnosis alone. We obtained a physician checklist or medical chart for 251 individuals who reported SLE, of whom 212 (84%) fulfilled ACR criteria for definite or probable SLE, or had clinical lupus ( SLE diagnosis recorded in medical charts plus appropriate medication use). The use of LSQ score or medication use in addition to self-report of SLE tended to decrease the false positive rate but also to reduce the proportion of true cases identified. Checklists of ACR criteria completed by subjects' physicians documented more criteria than medical records. In conclusion, among participants who consented to medical record review, SLE prediction algorithms using questions about lupus symptoms and medications offered slightly higher predictive value for detecting cases than self-reported diagnosis alone, but at the cost of case detection. SLE case confirmation strategies can be complemented by the use of criteria checklists sent directly to participants' physicians.