用于抽动障碍神经流行病学调查的筛查工具的验证。

Validation of screening instruments for neuroepidemiological surveys of tic disorders.

机构信息

Neurology Department, General Yagüe Hospital, Burgos, Spain.

出版信息

Mov Disord. 2011 Feb 15;26(3):520-6. doi: 10.1002/mds.23460. Epub 2011 Jan 21.

DOI:10.1002/mds.23460

PMID:21259342

Abstract

BACKGROUND

The main purpose was to validate a multistage protocol to screen tic disorders in mainstream and special education centers and to investigate whether telephone-based interviews were accurate to diagnose tic disorders when compared with in-person neurological interviews.

METHODS

A school-based survey of children and adolescents (6-16 years). A proxy report questionnaire for tic disorders was completed by teachers, observers, and parents. The diagnosis was confirmed by the neurologist based on the Diagnostic and Statistical Manual of Mental disorders (DSM-IV TR) criteria. The sensitivity, specificity, positive and negative predictive values, the likelihood ratio for a positive result (LR+), and the Kappa coefficients (k) for telephone-based interviews reliability were calculated.

RESULTS

One hundred twenty subjects, 57 from special education center and 63 from a mainstream school were studied. The sensitivity of the proxy report questionnaire was 58% and 36% when completed by the observers (mainstream and special education center, respectively), 40 and 73% when completed by the teachers, and 58 and 36% when completed by the parents. Using any of these 3 screening sources, the sensitivity was 92%, the positive predictive value was 38%, and negative predictive value was 97% (mainstream schools), whereas the sensitivity was 82%, the positive predictive value was 20%, and negative predictive value was 82% (special education centers). Parents (mainstream schools) and teachers (special education center) produced the highest LR+ (7.25 and 1.26, respectively) and the intraobserver reliability of the telephone-based interviews versus in-person neurological interviews gave a k coefficient of 0.83.

CONCLUSIONS

The efficiency of different screening instruments for tic disorders seems to vary in different settings. Telephone-based interviews may be a valid and convenient backup to ascertain the diagnosis of tic disorders when face-to-face neurological examination is not possible.

摘要

背景

本研究的主要目的是验证一个多阶段方案，以筛选主流和特殊教育中心的抽动障碍，并探讨电话访谈与面对面的神经学访谈相比，是否能准确诊断抽动障碍。

方法

这是一项基于学校的儿童和青少年（6-16 岁）调查。由教师、观察人员和家长完成代理报告问卷，用于抽动障碍。根据《精神障碍诊断与统计手册》（DSM-IV-TR）标准，由神经科医生确诊。计算了电话访谈的灵敏度、特异性、阳性和阴性预测值、阳性结果的似然比（LR+）以及可靠性的 Kappa 系数（k）。

结果

共 120 名受试者，其中 57 名来自特殊教育中心，63 名来自主流学校。观察者（主流和特殊教育中心）完成的代理报告问卷的灵敏度分别为 58%和 36%，教师完成的灵敏度分别为 40%和 73%，家长完成的灵敏度分别为 58%和 36%。使用这 3 种筛查来源中的任何一种，灵敏度为 92%，阳性预测值为 38%，阴性预测值为 97%（主流学校），而灵敏度为 82%，阳性预测值为 20%，阴性预测值为 82%（特殊教育中心）。家长（主流学校）和教师（特殊教育中心）产生的最高 LR+分别为 7.25 和 1.26，电话访谈的观察者内可靠性与面对面神经学访谈的 k 系数为 0.83。