制定妊娠癫痫核心结局集(E-CORE):一项全国性多利益相关者改良德尔菲共识研究。

Development of a core outcome set for epilepsy in pregnancy (E-CORE): a national multi-stakeholder modified Delphi consensus study.

机构信息

Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Barts Health NHS Trust, London, UK.

出版信息

BJOG. 2017 Mar;124(4):661-667. doi: 10.1111/1471-0528.14430. Epub 2016 Nov 16.

Abstract

OBJECTIVE

To develop a set of core outcomes for studies on pregnant women with epilepsy.

DESIGN

Delphi consensus study.

POPULATION

Healthcare professionals, and patient representatives with lived experience of epilepsy in the UK.

METHODS

We used a modified Delphi method and a consultation meeting to achieve consensus. Potential outcomes were identified by systematic review, and were scored using a Likert scale anchored between 1 (least important) and 5 (most important). We included outcomes that scored ≥4 by >70% of participants, and outcomes that scored ≤2 by <15% of participants.

MAIN OUTCOME MEASURES

Outcomes in studies on epilepsy in pregnancy.

RESULTS

Seventy-five healthcare professionals completed the first round, 48 (64%) completed the second round, and 37 (49%) completed the third round of the survey. Twenty-four patient representatives participated. The final core outcome set included 31 outcomes in three domains: neurological, offspring, and obstetric. Outcomes in the neurological domain were seizure control in pregnancy and postpartum, status epilepticus, maternal mortality, drowning, sudden unexpected death in epilepsy, postnatal depression, and quality of life. Offspring domain included congenital abnormalities (major and minor), fetal anticonvulsant syndrome, neurodevelopment, autism disorder, neonatal clinical complications, admission to a neonatal intensive care unit, and anthropometric measurements. The obstetric domain included live birth, stillbirth, miscarriage, ectopic, termination of pregnancy, admission to a high dependency or intensive care unit, breastfeeding, mode of delivery, preterm birth, pre-eclampsia, and eclampsia. Outcomes specific for studies on anti-epileptic drugs (AEDs) included maternal AED toxicity, AED compliance, neonatal withdrawal symptoms, and neonatal haemorrhagic disease.

CONCLUSION

Embedding this core set in future clinical trials will promote the standardisation of reporting to inform clinical practice.

TWEETABLE ABSTRACT

A Delphi method identifying core outcomes for epilepsy in pregnancy. Final core set includes 31 outcomes.

摘要

目的

为孕妇癫痫研究制定一套核心结局。

设计

德尔菲共识研究。

人群

英国具有癫痫患者经验的医疗保健专业人员和患者代表。

方法

我们使用改良德尔菲法和咨询会议达成共识。通过系统评价确定潜在结局,并使用 1(最不重要)至 5(最重要)锚定的李克特量表进行评分。我们纳入评分≥4 且>70%参与者认为重要,以及评分≤2 且<15%参与者认为不重要的结局。

主要观察指标

妊娠癫痫研究的结局。

结果

75 名医疗保健专业人员完成了第一轮调查,48 名(64%)完成了第二轮,37 名(49%)完成了第三轮调查。24 名患者代表参与。最终的核心结局集包括三个领域的 31 个结局:神经、后代和产科。神经领域的结局包括妊娠和产后的癫痫控制、癫痫持续状态、孕产妇死亡率、溺水、癫痫猝死、产后抑郁和生活质量。后代领域包括先天畸形(主要和次要)、胎儿抗惊厥综合征、神经发育、自闭症障碍、新生儿临床并发症、入住新生儿重症监护病房和人体测量。产科领域包括活产、死产、流产、异位妊娠、终止妊娠、入住高度依赖或重症监护病房、母乳喂养、分娩方式、早产、子痫前期和子痫。针对抗癫痫药物(AED)研究的具体结局包括孕产妇 AED 毒性、AED 依从性、新生儿戒断症状和新生儿出血性疾病。

结论

将该核心集纳入未来的临床试验中,将促进报告的标准化,为临床实践提供信息。

研究结果推特摘要

采用德尔菲法确定妊娠癫痫的核心结局。最终核心集包括 31 个结局。

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