Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
J Urol. 2010 Apr;183(4):1568-72. doi: 10.1016/j.juro.2009.12.042. Epub 2010 Feb 21.
An increasing number of parents and practitioners use the Internet for health related purposes, and an increasing number of models are available on the Internet for predicting spontaneous resolution rates for children with vesicoureteral reflux. We sought to determine whether currently available Internet based calculators for vesicoureteral reflux resolution produce systematically different results.
Following a systematic Internet search we identified 3 Internet based calculators of spontaneous resolution rates for children with vesicoureteral reflux, of which 2 were academic affiliated and 1 was industry affiliated. We generated a random cohort of 100 hypothetical patients with a wide range of clinical characteristics and entered the data on each patient into each calculator. We then compared the results from the calculators in terms of mean predicted resolution probability and number of cases deemed likely to resolve at various cutoff probabilities.
Mean predicted resolution probabilities were 41% and 36% (range 31% to 41%) for the 2 academic affiliated calculators and 33% for the industry affiliated calculator (p = 0.02). For some patients the calculators produced markedly different probabilities of spontaneous resolution, in some instances ranging from 24% to 89% for the same patient. At thresholds greater than 5%, 10% and 25% probability of spontaneous resolution the calculators differed significantly regarding whether cases would resolve (all p <0.0001).
Predicted probabilities of spontaneous resolution of vesicoureteral reflux differ significantly among Internet based calculators. For certain patients, particularly those with a lower probability of spontaneous resolution, these differences can significantly influence clinical decision making.
越来越多的家长和从业者出于健康相关的目的使用互联网，并且互联网上有越来越多的模型可用于预测儿童膀胱输尿管反流自发缓解率。我们旨在确定目前基于互联网的膀胱输尿管反流缓解计算器是否会产生系统的不同结果。
通过系统的互联网搜索，我们确定了 3 种基于互联网的儿童膀胱输尿管反流自发缓解率计算器，其中 2 种是学术附属的，1 种是行业附属的。我们生成了 100 名具有广泛临床特征的假设患者的随机队列，并将每位患者的数据输入到每个计算器中。然后，我们根据计算器预测的平均缓解概率和在各种截止概率下被认为可能缓解的病例数量来比较计算器的结果。
2 个学术附属计算器的平均预测缓解概率分别为 41%和 36%（范围为 31%至 41%），而行业附属计算器为 33%（p = 0.02）。对于某些患者，计算器产生的自发缓解概率差异很大，在某些情况下，同一患者的概率范围从 24%到 89%不等。在高于 5%、10%和 25%的自发缓解概率阈值下，计算器在病例是否会缓解方面存在显著差异（均 p <0.0001）。
基于互联网的膀胱输尿管反流自发缓解计算器的预测概率差异很大。对于某些患者，特别是那些自发缓解概率较低的患者，这些差异可能会显著影响临床决策。
