Systematic review of clinical prediction rules for neuroimaging in the evaluation of dementia
Systematic review of clinical prediction rules for neuroimaging in the evaluation of dementia
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DOI：
10.1001/archinte.160.18.2855
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发表时间：
2000-10-09
影响因子：
--
通讯作者：
Vickrey, BG
中科院分区：
文献类型：
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作者：
Gifford, DR;Holloway, RG;Vickrey, BG
背景资料：痴呆症的临床实践指南不推荐常规神经影像学检查，但在推荐的临床预测规则中有所不同，以确定哪些患者应该接受神经影像学检查，以确定痴呆症的潜在可逆原因。使用MEDLINE检索，辅以其他策略，我们确定了从1983年1月1日至1998年12月31日的研究，评估了临床预测规则的诊断性能。我们计算了每个规则的敏感性和特异性，然后在一个假设的1000例痴呆患者队列中评估了它们的诊断性能，潜在可逆性痴呆的患病率从1%到15%.Results：我们确定了7项研究，评估了6种不同临床预测规则中的至少一种。在所有研究中，只有一个规则始终具有高灵敏度（> 85%）;没有一个规则始终具有高特异性（> 85%）。7项研究中有6项包括少于15例潜在可逆性痴呆病例;因此，每项规则的敏感性和特异性都有相对较宽的置信区间。在潜在可逆性痴呆的患病率为5%时，所有规则在我们假设的队列中具有较低的阳性预测值（15%）。根据该规则，我们的分析预测6至44的50例潜在可逆性痴呆（5%的患病率在队列中的1000例患者）将不接受imaging. Conclusions：有相当大的不确定性的证据基础的临床预测规则，以确定哪些痴呆患者应该接受神经影像学检查。这些规则的应用可能会错过具有潜在可逆性痴呆原因的患者。
Background: Clinical practice guidelines for dementia do not recommend routine neuroimaging but vary in their recommended clinical prediction rules to identify patients who should undergo neuroimaging for potentially reversible causes of dementia.Methods: Using a MEDLINE search supplemented by other strategies, we identified studies from January 1, 1983, through December 31, 1998, that evaluated the diagnostic performance of a clinical prediction rule. We calculated the sensitivity and specificity of each rule, then evaluated their diagnostic performance in a hypothetical cohort of 1000 patients with dementia, varying the prevalence of potentially reversible dementia from 1% to 15%.Results: We identified 7 studies that evaluated at least 1 of 6 different clinical prediction rules. Only one rule consistently had high sensitivity (>85%) across all stud-ies; none consistently had high specificity (>85%). Six of the 7 studies included less than 15 cases of potentially reversible dementia; thus the sensitivity and specificity for each rule bad relatively wide confidence intervals. At a 5% prevalence of potentially reversible dementia, all rules had low positive predictive value ((15%) in our hypothetical cohort. Depending on the rule, our analysis predicts 6 to 44 of the 50 patients with potentially reversible dementia (5% prevalence in cohort of 1000 patients) would not undergo imaging.Conclusions: There is considerable uncertainty in the evidence underlying clinical prediction rules to identify which patients with dementia should undergo neuroimaging. Application of these rules may miss patients with potentially reversible causes of dementia.