Carpio Arturo, Lisanti Noemí, Calle Hugo, Borrero Inés, Torres María Elisa, Toral Ana María, Vásquez Ismael
Facultad de Ciencias Médicas, Universidad de Cuenca, Ecuador.
Rev Panam Salud Publica. 2006 Mar;19(3):157-62. doi: 10.1590/s1020-49892006000300003.
To evaluate the usefulness of a questionnaire in primary health care services for establishing the diagnosis of epilepsy in children from 1 to 10 years old and for classifying their epileptic seizures.
This cross-sectional observational study was conducted in 2004. There were 204 children in the study (102 diagnosed with epilepsy and 102 without epilepsy). The children were randomly selected at the Regional Center of Epilepsies and the Vincent Corral Moscoso Hospital, which are both in the city of Cuenca, Ecuador. For the study, each child with epilepsy was matched with a child without epilepsy, in two age groups: 1 to 5 years old and 6 to 10 years old. Four students who were in their last academic year in the School of Medicine of Cuenca and who did not know the child's diagnosis utilized the questionnaire with a family member or other guardian of the child. The validity, sensitivity, specificity, positive predictive value, and negative predictive value of the questionnaire were calculated, with 95% confidence intervals (95% CIs). The clinical diagnosis carried out by specialists was used as the gold standard.
The assessment showed that the questionnaire had good sensitivity (95.10%; 95% CI: 94.58%-95.61%) and good specificity (97.06%; 95% CI: 96.58%-97.59%). Validity was 96.08% (95% CI: 95.84%-96.36%), with a positive predictive value of 97.00% (95% CI: 96.48%-97.52%) and a negative predictive value of 95.19% (95% CI: 94.74%-95.74%). The level of agreement in the classification of the epileptic seizures carried out by the neurologists and by the medical students who used the questionnaire was satisfactory for the generalized seizures (kappa = 0.67). Upon testing for interobserver agreement among the specialists, the kappa value for the diagnoses was 0.80 among the neurologists and 0.89 among the pediatricians.
The diagnostic questionnaire that was assessed has good sensitivity and adequate specificity, and, after brief training, primary health care general practitioners can use it to help them diagnose epileptic seizures.
评估一份问卷在初级卫生保健服务中用于确诊1至10岁儿童癫痫及对其癫痫发作进行分类的效用。
这项横断面观察性研究于2004年开展。研究中有204名儿童（102名被诊断为癫痫，102名无癫痫）。这些儿童是在厄瓜多尔昆卡市的癫痫区域中心和文森特·科拉尔·莫斯科索医院随机选取的。对于该研究，将每名癫痫儿童与一名无癫痫儿童按两个年龄组进行匹配：1至5岁组和6至10岁组。四名昆卡医学院最后一学年的学生在不知儿童诊断结果的情况下，与儿童的一名家庭成员或其他监护人一起使用该问卷。计算了问卷的效度、敏感性、特异性、阳性预测值和阴性预测值，并给出95%置信区间（95%CI）。以专家进行的临床诊断作为金标准。
评估显示该问卷具有良好的敏感性（95.10%；95%CI：94.58% - 95.61%）和良好的特异性（97.06%；95%CI：96.58% - 97.59%）。效度为96.08%（95%CI：95.84% - 96.36%），阳性预测值为97.00%（95%CI：96.48% - 97.52%），阴性预测值为95.19%（95%CI：94.74% - 95.74%）。神经科医生和使用该问卷的医学生对癫痫发作分类的一致性水平对于全身性发作而言是令人满意的（kappa = 0.67）。在检测专家之间的观察者间一致性时，神经科医生诊断的kappa值为0.80，儿科医生诊断的kappa值为0.89。
所评估的诊断问卷具有良好的敏感性和足够的特异性，并且经过简短培训后，初级卫生保健全科医生可以使用它来辅助诊断癫痫发作。
