Failed validation of risk prediction model for intervention in renal colic patients after emergency department evaluation
Failed validation of risk prediction model for intervention in renal colic patients after emergency department evaluation
复制标题
DOI：
10.1111/ans.13109
复制
发表时间：
2016-11-01
影响因子：
1.7
通讯作者：
Kelly, Anne-Maree
中科院分区：
文献类型：
--
作者：
Dean, Tanya;Crozier, Jack;Kelly, Anne-Maree
背景资料：据报道，三个标准（结石大小>= 6 mm，出院时视觉模拟量表疼痛评分>= 2 cm和位置在输尿管中段以上; Papa标准）对于预测在索引急诊科（艾德）就诊28天内需要干预（手术或碎石术）的输尿管绞痛患者是敏感的。有人认为，缺乏这些标准确定了一组可能不需要早期随访。未报告确认。我们的目的是验证这些criteris.Methods：回顾性队列研究患者的临床表现输尿管绞痛和放射学证实的肾结石。收集的数据包括人口统计学、临床特征、结石特征、成像结果和28天结局。关注的结果是通过临床性能分析预测泌尿外科干预的Papa标准的性能。我们还进行了事后分析，以确定预测因素的泌尿外科干预组的整体和亚组出院的艾德。结果：二百二十四例患者进行了研究（中位年龄49，79%男性）与75（33%）需要泌尿外科干预28天内。任何一项Papa标准的存在对泌尿外科干预的敏感性为83.9%（95%置信区间（CI）71.2-91.9%），特异性为47.7%（95% CI 38.9-56.6%），阳性预测值40.9%（95% CI 31.9-50.4%），阴性预测值87.3%（95% CI 76.8-93.7%）。9例无Papa标准的患者进行了干预：12.7%（95%CI 6.8-22.4%）。结论：Papa标准不足以准确地确定哪些患者需要干预或哪些亚组不需要专科泌尿科随访。
Background: It has been reported that three criteria (size of calculus >= 6 mm, visual analogue scale pain score at discharge >= 2 cm and location above mid-ureter; the Papa criteria) were sensitive for predicting patients who require intervention (surgery or lithotripsy) within 28 days of index emergency department (ED) visit for ureteric colic. It was suggested that absence of these criteria identified a group for whom early follow-up may not be needed. No validation has been reported. We aimed to validate these criteria.Methods: Retrospective cohort study of patients with clinical presentation of ureteric colic and radiologically proven renal tract stones. Data collected included demographics, clinical features, features of the stone, imaging results and 28-day outcome. Outcome of interest was performance of the Papa criteria for prediction of urological intervention by clinical performance analysis. We also undertook a post hoc analysis to identify predictors of urological intervention for the group overall and for the subgroup discharged from ED.Results: Two hundred and twenty-four patients were studied (median age 49, 79% male) with 75 (33%) requiring urological intervention within 28 days. The presence of any of the Papa criteria had sensitivity for urological intervention of 83.9% (95% confidence interval (CI) 71.2-91.9%) with specificity of 47.7% (95% CI 38.9-56.6%), positive predictive value of 40.9% (95% CI 31.9-50.4%) and negative predictive value of 87.3% (95% CI 76.8-93.7%). Nine patients with no Papa criteria had intervention: 12.7% (95% CI 6.8-22.4%).Conclusion: The Papa criteria are not sufficiently accurate to determine which patients require intervention or a subgroup who do not need specialist urological follow-up.