Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
J Allergy Clin Immunol. 2013 Dec;132(6):1303-10. doi: 10.1016/j.jaci.2013.07.007. Epub 2013 Aug 26.
The Prevention and Incidence of Asthma and Mite Allergy (PIAMA) risk score predicts the probability of having asthma at school age among preschool children with suggestive symptoms.
We sought to externally validate the PIAMA risk score at different ages and in ethnic and socioeconomic subgroups of children in addition to updating it.
We studied 2877 children with preschool asthma-like symptoms participating in the multiethnic, prospective, population-based cohort study Generation R. The PIAMA risk score was assessed at preschool age, and asthma was predicted at age 6 years. Discrimination (concordance index [C-index]) and calibration were calculated. The PIAMA risk score was updated, and its performance was similarly analyzed.
At age 6 years, 6% (168/2877) of the children had asthma. The discriminative ability of the original PIAMA risk score to predict asthma in Generation R was similar compared with that in the PIAMA cohort (C-index = 0.74 vs 0.71). The predicted risks by using the original PIAMA risk score for having asthma at the age of 6 years tended to be slightly higher than the observed risks (8% vs 6%). No differences in discriminative ability were found at different ages or in ethnic and socioeconomic subgroups (P > .05). The updated PIAMA risk score had a C-index of 0.75.
The PIAMA risk score showed good external validity. The discriminative ability was similar at different ages and in ethnic and socioeconomic subgroups of preschool children, which suggests good generalizability. Further studies are needed to reproduce the predictive performance of the updated PIAMA risk score in other populations and settings and to assess its clinical relevance.
预防和发生哮喘和螨过敏（PIAMA）风险评分可预测有疑似症状的学龄前儿童在学龄期患哮喘的概率。
我们试图在不同年龄以及不同种族和社会经济亚组的儿童中对 PIAMA 风险评分进行外部验证，并对其进行更新。
我们研究了 2877 名有学龄前哮喘样症状的儿童，他们参加了多民族、前瞻性、基于人群的队列研究 Generation R。在学龄前评估 PIAMA 风险评分，并预测 6 岁时的哮喘。计算了区分度（一致性指数[C 指数]）和校准。更新了 PIAMA 风险评分，并对其性能进行了类似分析。
在 6 岁时，2877 名儿童中有 6%（168/2877）患有哮喘。与 PIAMA 队列相比，原始 PIAMA 风险评分预测 Generation R 中哮喘的能力具有相似的判别能力（C 指数=0.74 与 0.71）。使用原始 PIAMA 风险评分预测 6 岁时患哮喘的风险略高于观察到的风险（8%比 6%）。在不同年龄或不同种族和社会经济亚组中，判别能力没有差异（P>.05）。更新后的 PIAMA 风险评分的 C 指数为 0.75。
PIAMA 风险评分具有良好的外部有效性。在不同年龄以及不同种族和社会经济亚组的学龄前儿童中，判别能力相似，这表明其具有良好的普遍性。需要进一步的研究来复制更新后的 PIAMA 风险评分在其他人群和环境中的预测性能，并评估其临床相关性。
