Abawi Ozair, van den Berg Rosaline, van der Heijde Désirée, van Gaalen Floris A
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
RMD Open. 2017 Apr 7;3(1):e000389. doi: 10.1136/rmdopen-2016-000389. eCollection 2017.
Several models have been proposed to refer patients with possible axial spondyloarthritis (axSpA) to a rheumatologist. Our aim was to evaluate performance of these models in a single cohort.
13 referral models found in the literature were evaluated in the Leiden SPondyloArthritis Caught Early (SPACE) cohort, which includes patients with back pain (≥3 months, ≤2 years, onset <45 years; n=261) referred to a rheumatology outpatient clinic. Imaging was not considered as a referral parameter. Performance of the strategies was evaluated (sensitivity, specificity, positive likelihood ratio (LR+)) using diagnosis by a rheumatologist as an external standard. For secondary analyses, fulfilment of the Assessment in SpondyloArthritis international Society (ASAS) axSpA criteria was used as an external standard.
In total, 107/261 patients were diagnosed with axSpA. Most models performed well regarding sensitivity and specificity. The MASTER strategy showed a balanced sensitivity/specificity with the highest LR+. The ASAS and Brandt I strategies are the most sensitive strategies. Using classification by ASAS axSpA criteria as the external standard gave comparable results. Most patients missed by the strategies fulfilled the imaging arm of the ASAS axSpA criteria.
Most referral models performed well, although patients in SPACE have already been referred, which may have led to overestimation of performance. If no patient is to be missed, the ASAS strategy would be most preferable. If the number of referrals needs to be limited, the MASTER strategy seems to perform best. The 'ideal' referral strategy may be different from country to country, due to differences in healthcare structure and prevalence of referral parameters such as human leucocyte antigen-B27.
已经提出了几种模型，用于将可能患有中轴型脊柱关节炎（axSpA）的患者转诊给风湿病专科医生。我们的目的是在单一队列中评估这些模型的性能。
在莱顿早期发现的脊柱关节炎（SPACE）队列中评估了文献中找到的13种转诊模型，该队列包括转诊至风湿病门诊的背痛患者（≥3个月，≤2年，发病年龄<45岁；n = 261）。影像学未被视为转诊参数。以风湿病专科医生的诊断作为外部标准，评估这些策略的性能（敏感性、特异性、阳性似然比（LR+））。对于二次分析，以国际脊柱关节炎评估协会（ASAS）axSpA标准的满足情况作为外部标准。
总共261例患者中有107例被诊断为axSpA。大多数模型在敏感性和特异性方面表现良好。MASTER策略显示出平衡的敏感性/特异性，且LR+最高。ASAS和布兰特I策略是最敏感的策略。以ASAS axSpA标准分类作为外部标准得出了类似的结果。这些策略遗漏的大多数患者符合ASAS axSpA标准的影像学标准。
大多数转诊模型表现良好，尽管SPACE队列中的患者已经被转诊，这可能导致对性能的高估。如果不能遗漏任何患者，ASAS策略将是最可取的。如果需要限制转诊数量，MASTER策略似乎表现最佳。由于医疗结构以及人类白细胞抗原-B27等转诊参数患病率的差异，“理想”的转诊策略可能因国家而异。
