Accuracy of Patient Self-Report of Stroke: A Systematic Review from the UK Biobank Stroke Outcomes Group.
Accuracy of Patient Self-Report of Stroke: A Systematic Review from the UK Biobank Stroke Outcomes Group.
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DOI：
10.1371/journal.pone.0137538
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Sudlow CL
中科院分区：
文献类型：
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作者：
Woodfield R;UK Biobank Stroke Outcomes Group;UK Biobank Follow-up and Outcomes Working Group;Sudlow CL
我们对患者自报卒中的准确性进行了系统回顾，以告知在大型前瞻性研究中确定和确认卒中病例的方法。我们寻找了比较患者自我报告与卒中参考标准的研究。我们提取了有关调查方法、应答率、参与者特征、使用的参考标准和自我报告的阳性预测值（PPV）的数据。在可能的情况下，我们还计算了敏感性，特异性，阴性预测值（NPV）和中风患病率。使用诊断研究质量评估工具（QUADAS-2）评估研究水平偏倚风险。从>1500篇识别的文章中，我们纳入了17项研究。大多数要求患者报告终生卒中史，但少数将回忆时间限制为≤5年。一些问题包括短暂性脑缺血发作（TIA）或卒中同义词。在QUADAS-2评估中，没有一项研究没有偏倚风险，最常见的偏倚原因是参考标准数据不完整，没有对自我报告状态的裁定者设盲，以及参与者应答率（<80%）。自我报告的PPV范围为22-87%（17项研究），灵敏度为36-98%（10项研究），特异性为96-99.6%（10项研究），NPV为88.2-99.9%（10项研究）。正如预期的那样，PPV随着中风患病率的增加而增加。在六项具有可用相关数据的研究中，如果确认的TIA被认为是真实的而不是假阳性中风，则除一项研究外，其他所有研究的自我报告PPV均>75%。无法评估回忆时间或所问问题对PPV或敏感性的影响。研究人群的特征强烈影响自我报告的准确性。在基于人群的研究中，卒中患病率较低，很大一部分自我报告的卒中可能是假阳性。因此，自我报告不太可能有助于在没有随后确认的情况下识别病例，但结合其他数据来源可能有助于病例确定。
We performed a systematic review of the accuracy of patient self-report of stroke to inform approaches to ascertaining and confirming stroke cases in large prospective studies. We sought studies comparing patient self-report against a reference standard for stroke. We extracted data on survey method(s), response rates, participant characteristics, the reference standard used, and the positive predictive value (PPV) of self-report. Where possible we also calculated sensitivity, specificity, negative predictive value (NPV), and stroke prevalence. Study-level risk of bias was assessed using the Quality Assessment of Diagnostic Studies tool (QUADAS-2). From >1500 identified articles, we included 17 studies. Most asked patients to report a lifetime history of stroke but a few limited recall time to ≤5 years. Some included questions for transient ischaemic attack (TIA) or stroke synonyms. No study was free of risk of bias in the QUADAS-2 assessment, the most frequent causes of bias being incomplete reference standard data, absence of blinding of adjudicators to self-report status, and participant response rates (<80%). PPV of self-report ranged from 22–87% (17 studies), sensitivity from 36–98% (10 studies), specificity from 96–99.6% (10 studies), and NPV from 88.2–99.9% (10 studies). PPV increased with stroke prevalence as expected. Among six studies with available relevant data, if confirmed TIAs were considered to be true rather than false positive strokes, PPV of self-report was >75% in all but one study. It was not possible to assess the influence of recall time or of the question(s) asked on PPV or sensitivity. Characteristics of the study population strongly influence self-report accuracy. In population-based studies with low stroke prevalence, a large proportion of self-reported strokes may be false positives. Self-report is therefore unlikely to be helpful for identifying cases without subsequent confirmation, but may be useful for case ascertainment in combination with other data sources.