Costa João, Swash Michael, de Carvalho Mamede
Neuromuscular Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, 1649028 Lisbon, Portugal.
Arch Neurol. 2012 Nov;69(11):1410-6. doi: 10.1001/archneurol.2012.254.
To estimate the potential diagnostic added value of the Awaji criteria for diagnosis of a myotrophiclateral sclerosis (ALS), which have been compared with the previously accepted gold standard the revised El Escorial criteria in several studies.
MEDLINE and Web of Science (until October2011).
We searched for studies testing the diagnostic accuracy of the Awaji criteria vs the revised El Escorial criteria in patients referred with suspected ALS.
Evaluation and data extraction of identified studies were done independently. The Quality Assessment of Diagnostic Accuracy Studies list was used to assess study quality. We determined the proportion of patients classified as having probable/definite ALS and derived indices of diagnostic performance(sensitivity, specificity, and diagnostic odds ratio). Quantitative data synthesis was accomplished through random-effects meta-analysis, and heterogeneity was assessed with the I2 test.
Eight studies were included (3 prospective and 5 retrospective) enrolling 1187 patients. Application of Awaji criteria led to a 23% (95% CI, 12% to 33%; I2=84%) increase in the proportion of patients classified as having probable/definite ALS. Diagnostic performance of the Awaji criteria was higher than the revised El Escorial criteria (pooled sensitivity: 81.1% [95%CI, 72.2% to 90.0%; I2=91%] vs 62.2% [95% CI, 49.4%to 75.1%; I2=93%]; pooled diagnostic odds ratio, 35.8[95% CI, 15.2 to 84.7; I2=3%] vs 8.7 [95% CI, 2.2 to 35.6;I2=50%]). Diagnostic accuracy of Awaji criteria was higher in bulbar- than in limb-onset cases.
The Awaji criteria have a significant clinical impact allowing earlier diagnosis and clinical trial entry in ALS.
评估淡路标准对诊断肌萎缩侧索硬化症（ALS）的潜在诊断附加价值，该标准在多项研究中已与先前公认的金标准——修订后的埃尔埃斯科里亚尔标准进行了比较。
MEDLINE和科学网（截至2011年1o月）。
我们检索了检测淡路标准与修订后的埃尔埃斯科里亚尔标准对疑似ALS患者诊断准确性的研究。
对纳入研究的评估和数据提取由独立完成。使用诊断准确性研究质量评估列表评估研究质量。我们确定了被归类为可能/确诊ALS的患者比例，并得出诊断性能指标（敏感性、特异性和诊断比值比）。通过随机效应荟萃分析完成定量数据合成，并用I²检验评估异质性。
纳入八项研究（三项前瞻性研究和五项回顾性研究），共1187例患者。应用淡路标准使被归类为可能/确诊ALS的患者比例增加了23%（95%CI，12%至33%；I²=84%）。淡路标准的诊断性能高于修订后的埃尔埃斯科里亚尔标准（合并敏感性：81.1%[95%CI，72.2%至90.0%；I²=91%]对62.2%[95%CI，49.4%至75.1%；I²=93%]；合并诊断比值比，35.8[95%CI，15.2至84.7；I²=3%]对8.7[95%CI，2.2至35.6；I²=50%]）。淡路标准在延髓起病型病例中的诊断准确性高于肢体起病型病例。
淡路标准具有显著的临床影响，可实现ALS的早期诊断并使其进入临床试验。
