Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada.
Acad Emerg Med. 2011 Mar;18(3):322-5. doi: 10.1111/j.1553-2712.2011.01009.x. Epub 2011 Feb 25.
The objective was to demonstrate the derivation and the preliminary validation of a brief screening score to improve recognition of panic-like anxiety in emergency department (ED) patients with unexplained chest pain.
This cross-sectional study included 507 ED patients with unexplained chest pain randomly assigned to the derivation condition (n = 201) or the validation condition (n = 306). The Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) acted as the criterion standard for panic diagnosis. Receiver operating characteristic (ROC) curves were used to determine which of the sociodemographic, medical, and questionnaire response variables best predicted the presence of panic-like anxiety in the derivation condition. The selected predictors were entered in a logistic regression analysis to determine variables to be included in the screening score. The predictive validity of the resulting score was evaluated in both conditions.
The four-item Panic Screening Score (PSS) identified panic-like anxiety with a sensitivity of 63% (95% confidence interval [CI] = 52% to 73%) and a specificity of 84% (95% CI = 76% to 90%) in the derivation phase. The positive predictive value was 74% (95% CI = 62% to 93%) and the negative predictive value was 76% (95% CI = 68% to 89%). In the validation phase, the sensitivity and specificity were 53% (95% CI = 44% to 62%) and 85% (95% CI = 78% to 89%), respectively. The positive predictive value was 72% (95% CI = 62% to 80%) and the negative predictive value was 71% (95% CI = 65% to 77%).
The PSS may be useful to identify patients with unexplained chest pain who could benefit from referral to mental health professionals or their primary care providers for evaluation of panic attack and panic disorder. Prospective studies to improve and validate the PSS, followed by impact analysis, are mandatory before clinical implementation.
本研究旨在开发并初步验证一种简短的筛查评分，以提高对急诊科（ED）不明原因胸痛患者惊恐样焦虑的识别率。
本横断面研究纳入了 507 例不明原因胸痛的 ED 患者，随机分配至推导条件（n = 201）或验证条件（n = 306）。DSM-IV 焦虑障碍访谈表（ADIS-IV）作为惊恐诊断的标准。受试者工作特征（ROC）曲线用于确定哪些社会人口学、医学和问卷反应变量最能预测推导条件中惊恐样焦虑的存在。选择预测因子进行逻辑回归分析，以确定要纳入筛查评分的变量。在两个条件下评估由此产生的评分的预测有效性。
四项惊恐筛查评分（PSS）在推导阶段识别惊恐样焦虑的敏感度为 63%（95%置信区间[CI] = 52%至 73%），特异性为 84%（95% CI = 76%至 90%）。阳性预测值为 74%（95% CI = 62%至 93%），阴性预测值为 76%（95% CI = 68%至 89%）。在验证阶段，敏感度和特异性分别为 53%（95% CI = 44%至 62%）和 85%（95% CI = 78%至 89%）。阳性预测值为 72%（95% CI = 62%至 80%），阴性预测值为 71%（95% CI = 65%至 77%）。
PSS 可能有助于识别不明原因胸痛的患者，这些患者可能受益于向心理健康专业人员或初级保健提供者转介，以评估惊恐发作和惊恐障碍。在临床实施之前，必须进行前瞻性研究以改进和验证 PSS，并进行影响分析。
