Department of Otorhinolaryngology and Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden.
Laryngoscope. 2012 Apr;122(4):901-6. doi: 10.1002/lary.23210. Epub 2012 Feb 28.
OBJECTIVES/HYPOTHESIS: To develop a clinical prognostic model to identify Bell's palsy patients with risk for nonrecovery at 12 months.
Data from a prospective, randomized, double-blind, placebo-controlled, multicenter study.
There were 829 patients with Bell's palsy randomized in a factorial fashion to treatment with prednisolone or no prednisolone. Facial function was assessed with the Sunnybrook grading scale. Univariate and multivariate logistic regression analyses at different time points were used to identify factors predicting nonrecovery, defined as Sunnybrook <70 at 12 months. Variables studied were age, gender, time to inclusion, prednisolone treatment, side of palsy, pain at inclusion, and Sunnybrook scores. Factors of predictable significance were used to construct prognostic models at baseline, days 11 to 17, and at 1 month. Receiver operating characteristics curves were created to test the predictive capacity of the models.
At baseline, treatment with prednisolone or no prednisolone (P = .0005), age (P = .04) and the Sunnybrook score (P = .0002) were significant factors for predicting nonrecovery. The receiver operating characteristics area under the curve at baseline for these three variables was 0.74 (sensitivity 0.83, specificity 0.57). At days 11 to 17 and at 1 month, the Sunnybrook score was the only significant predictive variable. The respective areas under the curves for the Sunnybrook score at these time points were 0.83 (sensitivity 0.81, specificity 0.75) and 0.94 (sensitivity 0.91, specificity 0.85).
Sunnybrook grading at 1 month most accurately predicts nonrecovery at 12 months in Bell's palsy.
目的/假设：开发一种临床预后模型，以识别 12 个月时无恢复风险的贝尔面瘫患者。
前瞻性、随机、双盲、安慰剂对照、多中心研究的数据。
829 例贝尔面瘫患者随机分为泼尼松龙或安慰剂治疗组。采用桑尼布鲁克分级量表评估面部功能。使用单变量和多变量逻辑回归分析在不同时间点识别预测无恢复的因素，定义为 12 个月时桑尼布鲁克评分<70。研究的变量包括年龄、性别、纳入时间、泼尼松龙治疗、面瘫侧、纳入时疼痛以及桑尼布鲁克评分。使用有预测意义的变量在基线、第 11-17 天和第 1 个月构建预后模型。绘制受试者工作特征曲线以检验模型的预测能力。
基线时，泼尼松龙或安慰剂治疗（P=0.0005）、年龄（P=0.04）和桑尼布鲁克评分（P=0.0002）是预测无恢复的显著因素。这三个变量的基线受试者工作特征曲线下面积为 0.74（敏感性 0.83，特异性 0.57）。在第 11-17 天和第 1 个月时，桑尼布鲁克评分是唯一有显著预测价值的变量。在这些时间点，桑尼布鲁克评分的相应曲线下面积分别为 0.83（敏感性 0.81，特异性 0.75）和 0.94（敏感性 0.91，特异性 0.85）。
1 个月时的桑尼布鲁克分级最能准确预测贝尔面瘫 12 个月时的无恢复情况。
