Value of witness observations in the differential diagnosis of transient loss of consciousness
Value of witness observations in the differential diagnosis of transient loss of consciousness
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DOI：
10.1212/wnl.0000000000007017
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发表时间：
2019-02-26
期刊：
影响因子：
9.9
通讯作者：
Reuber, Markus
中科院分区：
文献类型：
--
作者：
Chen, Min;Jamnadas-Khoda, Jenny;Reuber, Markus
这项回顾性研究探讨了使用新的31项阵发性事件观察者（PEO）问卷提供的事件目击者的额外信息在多大程度上改善了癫痫、晕厥和心因性非癫痫性癫痫发作（PNES）之间的区分，这些信息仅由患者提供。或PNES（n = 84）参加英国神经病学/晕厥专科服务，事件观察员提供阵发性事件特征（PEP）、PEO和个人信息（PI）（例如，性别、年龄、病史）数据。PEO数据进行探索性因素分析（EFA），然后进行验证性因素分析（CFA）。PEO、PEP和PI数据分别和组合使用，以通过成对和多项logistic回归区分诊断。预测诊断进行了比较，与金标准的医疗diagnosis.ResultsEFA/CFA确定了一个4-因素结构的PEO的基础上，26/31的问卷项目负荷>= 0.4。单独观察者报告的因素比患者报告的因素更能区分晕厥和癫痫（准确性：96% vs 85%，p = 0.0004）。观察者报告的数据提高了晕厥和癫痫之间基于患者报告数据的区分准确性，从90%提高到100%（p = 0.005），癫痫和PNES之间为76%至83%（p = 0.006），晕厥和PNES之间为93%~ 95（p = 0.098）.结论来自观察者的信息可以对癫痫与晕厥或PNES的鉴别做出重要贡献，但对晕厥与PNES的鉴别贡献较小。
ObjectiveThis retrospective study explores to what extent additional information from event witnesses provided using the novel 31-item Paroxysmal Event Observer (PEO) Questionnaire improves the differentiation among epilepsy, syncope, and psychogenic nonepileptic seizures (PNES) achievable with information provided by patients alone.MethodsPatients with transient loss of consciousness caused by proven epilepsy (n = 86), syncope (n = 79), or PNES (n = 84) attending specialist neurology/syncope services in the United Kingdom and event observers provided Paroxysmal Event Profile (PEP), PEO, and personal information (PI) (e.g., sex, age, medical history) data. PEO data were subjected to exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). PEO, PEP, and PI data were used separately and in combination to differentiate diagnoses by pairwise and multinomial logistic regressions. Predicted diagnoses were compared with gold standard medical diagnoses.ResultsEFA/CFA identified a 4-factor structure of the PEO based on 26/31 questionnaire items with loadings >= 0.4. Observer-reported factors alone differentiated better between syncope and epilepsy than patient-reported factors (accuracy: 96% vs 85%, p = 0.0004). Observer-reported data improved accuracy over differentiation based on patient-reported data alone from 90% to 100% between syncope and epilepsy (p = 0.005), 76% to 83% between epilepsy and PNES (p = 0.006), and 93% to 95% between syncope and PNES (p = 0.098).ConclusionsInformation from observers can make an important contribution to the differentiation of epilepsy from syncope or PNES but adds less to that of syncope from PNES.