Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland.
J Allergy Clin Immunol. 2014 Jan;133(1):111-8.e1-13. doi: 10.1016/j.jaci.2013.06.002. Epub 2013 Jul 24.
Many preschool children have wheeze or cough, but only some have asthma later. Existing prediction tools are difficult to apply in clinical practice or exhibit methodological weaknesses.
We sought to develop a simple and robust tool for predicting asthma at school age in preschool children with wheeze or cough.
From a population-based cohort in Leicestershire, United Kingdom, we included 1- to 3-year-old subjects seeing a doctor for wheeze or cough and assessed the prevalence of asthma 5 years later. We considered only noninvasive predictors that are easy to assess in primary care: demographic and perinatal data, eczema, upper and lower respiratory tract symptoms, and family history of atopy. We developed a model using logistic regression, avoided overfitting with the least absolute shrinkage and selection operator penalty, and then simplified it to a practical tool. We performed internal validation and assessed its predictive performance using the scaled Brier score and the area under the receiver operating characteristic curve.
Of 1226 symptomatic children with follow-up information, 345 (28%) had asthma 5 years later. The tool consists of 10 predictors yielding a total score between 0 and 15: sex, age, wheeze without colds, wheeze frequency, activity disturbance, shortness of breath, exercise-related and aeroallergen-related wheeze/cough, eczema, and parental history of asthma/bronchitis. The scaled Brier scores for the internally validated model and tool were 0.20 and 0.16, and the areas under the receiver operating characteristic curves were 0.76 and 0.74, respectively.
This tool represents a simple, low-cost, and noninvasive method to predict the risk of later asthma in symptomatic preschool children, which is ready to be tested in other populations.
许多学龄前儿童有喘息或咳嗽，但只有部分儿童以后会发展为哮喘。现有的预测工具难以应用于临床实践，或存在方法学上的缺陷。
我们旨在开发一种简单而稳健的工具，用于预测有喘息或咳嗽的学龄前儿童在上学时发生哮喘的风险。
我们纳入了来自英国莱斯特郡的一个基于人群的队列中 1 至 3 岁因喘息或咳嗽就诊的儿童，并在 5 年后评估哮喘的患病率。我们仅考虑在初级保健中易于评估的非侵入性预测因素：人口统计学和围产期数据、特应性皮炎、上呼吸道和下呼吸道症状以及特应性家族史。我们使用逻辑回归建立模型，采用最小绝对收缩和选择算子惩罚避免过度拟合，然后将其简化为实用工具。我们进行了内部验证，并使用比例 Brier 评分和接收者操作特征曲线下面积评估其预测性能。
在有随访信息的 1226 例有症状儿童中，有 345 例（28%）在 5 年后患有哮喘。该工具由 10 个预测因素组成，总分为 0 至 15 分：性别、年龄、无感冒的喘息、喘息频率、活动障碍、呼吸急促、与运动相关的和与变应原相关的喘息/咳嗽、特应性皮炎以及父母哮喘/支气管炎史。内部验证模型和工具的比例 Brier 评分分别为 0.20 和 0.16，接收者操作特征曲线下面积分别为 0.76 和 0.74。
该工具代表了一种简单、低成本、非侵入性的方法，可用于预测有症状的学龄前儿童以后发生哮喘的风险，可在其他人群中进行测试。
