EngenderHealth, Columbia University, Brooklyn, NY 11215, USA.
Am J Obstet Gynecol. 2013 Feb;208(2):112.e1-11. doi: 10.1016/j.ajog.2012.11.040. Epub 2012 Nov 28.
The purpose of this study was to test the diagnostic performance of 5 existing classification systems (developed by Lawson, Tafesse, Goh, Waaldijk, and the World Health Organization) and a prognostic scoring system that was derived empirically from our data to predict fistula closure 3 months after surgery.
Women with genitourinary fistula (n = 1274) who received surgical repair services at 11 health facilities in sub-Saharan Africa and Asia were enrolled in a prospective cohort study. Using one-half of the sample, we created multivariate generalized estimating equation models to obtain weighted prognostic scores for components of each existing classification system and the empirically derived scoring system. With the second one-half, we developed receiver operating characteristic curves using the prognostic scores and calculated areas under the curves (AUCs) and 95% confidence intervals (CIs) for each system.
Among existing systems, the scoring systems that represented the World Health Organization, Goh, and Tafesse classifications had the highest predictive accuracy: AUC, 0.63 (95% CI, 0.57-0.68); AUC, 0.62 (95% CI, 0.57-0.68), and AUC, 0.60 (95% CI, 0.55-0.65), respectively. The empirically derived prognostic score achieved similar predictive accuracy (AUC, 0.62; 95% CI, 0.56-0.67); it included significant predictors of closure that are found in the other classification systems, but contained fewer, nonoverlapping components. The differences in AUCs were not statistically significant.
The prognostic values of existing urinary fistula classification systems and the empirically derived score were poor to fair. Further evaluation of the validity and reliability of existing classification systems to predict fistula closure is warranted; consideration should be given to a prognostic score that is evidence-based, simple, and easy to use.
本研究旨在检验 5 种现有分类系统（由 Lawson、Tafesse、Goh、Waaldijk 和世界卫生组织制定）以及从我们的数据中得出的经验预后评分系统的诊断性能，以预测手术后 3 个月瘘管闭合情况。
在撒哈拉以南非洲和亚洲的 11 个卫生设施接受手术修复服务的女性尿瘘患者（n=1274）参与了一项前瞻性队列研究。我们使用样本的一半建立了多变量广义估计方程模型，以获得每个现有分类系统和经验衍生评分系统的组成部分的加权预后评分。使用另一半，我们使用预后评分绘制了接受者操作特征曲线，并计算了每个系统的曲线下面积（AUC）和 95%置信区间（CI）。
在现有系统中，代表世界卫生组织、Goh 和 Tafesse 分类的评分系统具有最高的预测准确性：AUC，0.63（95%CI，0.57-0.68）；AUC，0.62（95%CI，0.57-0.68）和 AUC，0.60（95%CI，0.55-0.65）。经验衍生的预后评分具有相似的预测准确性（AUC，0.62；95%CI，0.56-0.67）；它包含了其他分类系统中发现的与闭合相关的重要预测因素，但包含的成分更少，不重叠。AUC 之间的差异无统计学意义。
现有尿瘘分类系统和经验衍生评分的预后价值较差到一般。需要进一步评估现有分类系统预测瘘管闭合的有效性和可靠性；应考虑使用基于证据、简单易用的预后评分。
