疑似舟状骨骨折的诊断性能测试因传统分析和潜在类别分析而有所不同。
Diagnostic performance tests for suspected scaphoid fractures differ with conventional and latent class analysis.
机构信息
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
出版信息
Clin Orthop Relat Res. 2011 Dec;469(12):3400-7. doi: 10.1007/s11999-011-2074-9. Epub 2011 Sep 30.
BACKGROUND
Evaluation of the diagnostic performance characteristics of radiographic tests for diagnosing a true fracture among suspected scaphoid fractures is hindered by the lack of a consensus reference standard. Latent class analysis is a statistical method that takes advantage of unobserved, or latent, classes in the data that can be used to determine diagnostic performance characteristics when there is no consensus reference (gold) standard.
PURPOSES
We therefore compared the diagnostic performance characteristics of MRI, CT, bone scintigraphy, and physical examination to identify true fractures among suspected scaphoid fractures.
PATIENTS AND METHODS
We used data from two studies, one that prospectively studied 34 patients who had MRI and CT of the wrist, and a second that studied 78 patients who had MRI, bone scintigraphy, and structured physical examination. We compared the diagnostic performance characteristics calculated by latent class analysis with those calculated using formulas based on a reference standard.
RESULTS
In the first cohort, the calculated sensitivity and specificity with latent class analysis were different than those with traditional reference standard-based calculations for the CT in the scaphoid planes (sensitivity, 0.78 versus 0.67; specificity, 1.0 versus 0.96) and the MRI (sensitivity, 0.80 versus 0.67; specificity, 0.93 versus 0.89). In the second cohort, the greatest differences were in the sensitivity of MRI (0.84 versus 0.75) and the sensitivities of physical examination maneuvers (range, 0.63-0.73 versus 1.0).
CONCLUSIONS
The diagnostic performance characteristics calculated using latent class analysis may differ from those calculated according to formulas based on a reference standard. We believe latent class analysis merits further study as an option for assessing diagnostic performance characteristics for orthopaedic conditions when there is no consensus reference standard.
LEVEL OF EVIDENCE
Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
背景
评估疑似舟状骨骨折的放射学检查诊断真性骨折的诊断性能特征受到缺乏共识参考标准的阻碍。潜在类别分析是一种利用数据中未观察到或潜在类别（潜在类别）的统计方法，当没有共识参考（金）标准时，可用于确定诊断性能特征。
目的
因此，我们比较了 MRI、CT、骨闪烁扫描和体格检查在诊断疑似舟状骨骨折中的真性骨折的诊断性能特征。
患者和方法
我们使用了两项研究的数据，一项前瞻性研究了 34 例手腕 MRI 和 CT 的患者，另一项研究了 78 例接受 MRI、骨闪烁扫描和结构化体格检查的患者。我们比较了潜在类别分析计算的诊断性能特征与基于参考标准的公式计算的诊断性能特征。
结果
在第一组中，与传统基于参考标准的计算相比，潜在类别分析计算的 CT 在舟状骨平面的敏感性和特异性（敏感性，0.78 与 0.67；特异性，1.0 与 0.96）和 MRI（敏感性，0.80 与 0.67；特异性，0.93 与 0.89）有所不同。在第二组中，最大的差异在于 MRI 的敏感性（0.84 与 0.75）和体格检查手法的敏感性（范围，0.63-0.73 与 1.0）。
结论
使用潜在类别分析计算的诊断性能特征可能与基于参考标准的公式计算的诊断性能特征不同。我们认为，当没有共识参考标准时，潜在类别分析值得进一步研究，作为评估骨科疾病诊断性能特征的一种选择。
证据水平
II 级，预后研究。有关证据水平的完整描述，请参见作者指南。
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