NeurEx: digitalized neurological examination offers a novel high-resolution disability scale
NeurEx: digitalized neurological examination offers a novel high-resolution disability scale
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DOI：
10.1002/acn3.640
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发表时间：
2018-10-01
影响因子：
5.3
通讯作者：
Bielekova, Bibiana
中科院分区：
文献类型：
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作者：
Kosa, Peter;Barbour, Christopher;Bielekova, Bibiana
目的：建立一个敏感的神经功能缺损评分表，以便在临床上广泛使用。研究方法：结果我们采用了先进的移动的计算开发一个基于iPad的应用程序，方便的神经系统检查到一个安全的，云连接的数据库的文件。我们包括四个传统的神经免疫功能障碍量表中存在的功能，并将其自动计算编码。通过将神经功能缺损的空间分布与其严重程度的定量或半定量评级相结合，我们开发了一种新的汇总评分（称为NeurEx;范围从0到1349，最小可测量变化为0.25），并将其性能与临床医生和应用程序计算的传统临床量表进行了比较。结果如下：在906项神经系统检查的横断面比较中，App计算和临床医生评分的残疾量表之间的差异与多发性硬化症（MS）培训的临床医生对相同神经系统检查的评分之间的差异相当。通过消除评级模糊性，App计算量表在测量随时间推移的残疾进展方面实现了更高的准确性（研究n = 191例患者，超过880.6患者-年）。NeurEx评分没有明显的天花板效应，并且对于检测可测量的年度残疾进展（即，中位进展斜率为8.13，相对于最小可检测变化为0.25），而扩展残疾状态量表（EDSS）中位年进展斜率为0.071，低于EDSS的最小可测量变化0.5。解释：NeurEx可用作神经免疫学中高度敏感的结局指标。该应用程序可以很容易地修改，用于神经病学的其他领域，它可以桥梁私人执业医生到学术中心的多中心研究。
Objective: To develop a sensitive neurological disability scale for broad utilization in clinical practice. Methods: ResultsWe employed advances of mobile computing to develop an iPad-based App for convenient documentation of the neurological examination into a secure, cloud-linked database. We included features present in four traditional neuroimmunological disability scales and codified their automatic computation. By combining spatial distribution of the neurological deficit with quantitative or semiquantitative rating of its severity we developed a new summary score (called NeurEx; ranging from 0 to 1349 with minimal measurable change of 0.25) and compared its performance with clinician- and App-computed traditional clinical scales. Results: In the cross-sectional comparison of 906 neurological examinations, the variance between App-computed and clinician-scored disability scales was comparable to the variance between rating of the identical neurological examination by multiple sclerosis (MS)-trained clinicians. By eliminating rating ambiguity, App-computed scales achieved greater accuracy in measuring disability progression over time (n = 191 patients studied over 880.6 patient-years). The NeurEx score had no apparent ceiling effect and more than 200-fold higher sensitivity for detecting a measurable yearly disability progression (i.e., median progression slope of 8.13 relative to minimum detectable change of 0.25) than Expanded Disability Status Scale (EDSS) with a median yearly progression slope of 0.071 that is lower than the minimal measurable change on EDSS of 0.5. Interpretation: NeurEx can be used as a highly sensitive outcome measure in neuroimmunology. The App can be easily modified for use in other areas of neurology and it can bridge private practice practitioners to academic centers in multicenter research studies.