Multivariate CART for survival with dental applications

描述（由申请人提供）：牙周病或龋齿导致的牙齿脱落折磨着大多数成年人的一生。专业牙科治疗和个人口腔健康自我保健的目标是防止牙齿脱落，保持牙列自然舒适和功能。为了制定适当的牙科治疗计划，牙科保健专业人员必须权衡每颗牙齿保留的长期前景与每种治疗方案所涉及的成本和不适，患者和第三方付款人必须对所建议的牙科治疗的成本和这些治疗的长期成功概率做出价值判断。因此，在制定任何牙科治疗计划时，利用牙科预后是至关重要的。目标：本研究的主要目标是将新开发的分类和回归树（CART）的多变量扩展应用于从克赖顿大学牙科学院的AxiUm电子牙科记录系统中获得的大型去识别数据库，以建立基于实际牙齿脱落的全球牙科预后指标。我们还计划改进我们开发的用于多变量CART生存的计算机算法，以提高计算效率，并进一步将贝叶斯生存树和随机森林扩展到相关结果，以便利用最准确的程序建立牙齿预后受试者的分配标准。这些假设将在一个为期4年的纵向数据库中进行检验，该数据库由19092名在克莱顿大学牙科诊所接受治疗的男性、女性和儿童组成。在随访数据的19092名患者中，有4339名成年人是牙周门诊的常规患者，有牙周随访记录，而1681名是18岁以下的儿童。可用于检验假设的数据：一些记录中的年龄、性别、种族、牙齿脱落的时间、完整的修复和牙周随访记录、重要病史、吸烟、口腔卫生、特殊需求、依从性、看牙频率和其他参数的数据，这些数据是在克莱顿大学牙科学院牙科治疗和随访中收集的。意义：通过建立清晰、客观的标准来分配准确、基于证据的基于实际牙齿脱落的全球牙科预后指标，本研究有可能对牙科界产生巨大影响。采用和使用准确的、基于证据的全球牙科预后指标可以帮助牙科医生更好地制定治疗计划，帮助第三方支付计划更好地决定福利，并为患者提供一个对其牙科治疗需求做出知情决定的途径。

DESCRIPTION (provided by applicant): Tooth loss from periodontal disease or dental caries afflicts most adults over the course of their lives. Goals of professional dental treatment and of personal oral health self-care are to prevent tooth loss and maintain the natural dentition in a state of comfort and function. In order to develop appropriate dental treatment planning, dental health care professionals must weigh the long-term outlook for retention of each tooth against the cost and discomfort involved with each treatment option, and patients and third-party payers must make value judgments about the cost of suggested dental treatments against the probability of long-term success for those treatments. Hence, it is essential to utilize dental prognosis in the development of any dental treatment plan. Goals: The primary goal of this study is to apply newly developed multivariate extensions of Classification And Regression Trees (CART) for survival to a large, de-identified database obtained from the AxiUm system of electronic dental records at Creighton University School of Dentistry to establish global dental prognostic indicators based on actual tooth loss. We also plan to refine computer algorithms we developed for multivariate CART for survival to increase computing efficiency and further extend Bayesian survival trees and random forests to correlated outcomes in order to utilize the most accurate procedure for establishing criteria for assignment of dental prognosis Subjects: The hypotheses will be tested on a 4-year longitudinal database consisting of 19,092 men, women, and children with follow-up data who have been treated at the Creighton University dental clinic. Of the 19,092 patients with follow-up data, 4,339 adults are regular patients in the periodontal clinic with follow-up periodontal records while 1,681 are children under 18 years of age. Available data for testing hypotheses: Data for age, gender, race in some records, time until tooth loss, complete restorative and periodontal records with follow-up, significant medical history, smoking, oral hygiene, special needs, compliance, frequency of dental visits and other parameters that are collected as part of dental treatment and follow-up at the Creighton University School of Dentistry. Significance: By establishing clear, objective criteria for assignment of accurate, evidence-based global dental prognostic indicators that are based on actual tooth loss, this study has the potential to make a tremendous impact on the dental community. Adoption and use of accurate, evidence-based global dental prognostic indicators could aid dental practitioners in better treatment planning, help third-party payment plans make better decisions about benefits, and provide patients with an avenue for making informed decisions about their dental treatment needs. PUBLIC HEALTH RELEVANCE: The objective of this proposal is to identify simple, objective clinical criteria for assignment of global dental prognostic indicators that are based on actual tooth loss. The central hypothesis is that commonly used clinical measures can be used to forecast the long-term prognosis of any tooth in a patient's mouth at any given time. Development, adoption, and use of accurate, evidence-based global dental prognostic indicators has the potential for making a significant public health impact by aiding dental practitioners in better treatment planning, helping third-party payment plans make better decisions about benefits, and providing patients objective criteria for making informed decisions about their dental treatment needs.