预测性吞分数对中风患者的缺食症的外部验证
Salman Ikramuddin1, Martin Weiss2, Abhigyan Datta3
1Department of Neurology, University of Minnesota; Department of Neurology, University of Texas Health Sciences Houston.
概括
预测吞分数 (PRESS) 模型在美国队列中没有准确预测中风后食障碍的恢复. 由于模型性能差以及中风护理中的潜在差异,需要进一步验证.
科学领域:
- 神经学 神经学
- 临床医学 临床医学
- 康复 康复 康复 康复
背景情况:
- 脑卒中后消化不良 (PSD) 是急性缺血性脑卒中 (AIS) 后的常见并发症,影响吞功能恢复.
- 预测PSD恢复是具有挑战性的,需要可靠的预后模型.
- 在瑞士开发的预测吞分数 (PRESS) 模型旨在预测PSD恢复.
研究的目的:
- 为了验证PRESS模型在预测美国患者队列中吞恢复方面的表现.
- 在新的人群中评估PRESS模型的准确性和校准.
主要方法:
- 149名急性缺血性中风患者的回顾性审查和功能性口服量表 (FOIS) ≤4.
- 收集的PRESS预测因素:年龄,NIH中风量表 (NIHSS),任何2分数,中风位置和初始FOIS分数.
- 通过Hosmer-Lemeshow测试,校准图表和AUC分析对第7天结果进行模型验证.
主要成果:
- 在美国队列中,PRESS模型显示适合性差 (p<0.00001) 和校准性差 (截面=-0.80,斜率=0.60).
- 曲线下的面积 (AUC) 为0.75,表明在第7天预测吞恢复的次优歧视.
- 该模型过度预测了PRESS得分较高和中风较严重的患者的消化不良严重程度.
结论:
- 在这个美国队列中,PRESS模型表现不佳,无法准确预测中风后食障碍的恢复.
- 脑卒中治疗时间的差异,地理位置的差异和研究设计的差异可能解释了该模型的表现不佳.
- 建议进一步进行前性验证,考虑到中风护理的潜在进展和区域实践差异.
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