Lin Senlin, Ma Yingyan, Zou Haidong
Shanghai Eye Diseases Prevention & Treatment Center/Shanghai Eye Hospital, Shanghai, China.
Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.
J Eval Clin Pract. 2020 Apr;26(2):551-558. doi: 10.1111/jep.13311. Epub 2019 Nov 18.
To establish an enhanced Youden's index with net benefit, as a scientific method for optimal-threshold determination in shared decision making.
We redefined the Youden's index by changing the target function from the maximization of accuracy to the maximization of net benefit and established the process for pursuing the patient's individual optimal-threshold. In addition, we illustrated how the enhanced Youden's index works with an example of cataract operation decision making using the data from Shanghai, China.
We modified the method of calculating net benefit in decision curve analysis and fused it with Youden's index to expand the purpose from finding a threshold with the best test accuracy to finding one with the best net benefit. As an example, we used the enhanced Youden's index to establish an optimal-thresholds list for cataract operation decision making. Then, we calculated three imaginary patients' respective thresholds after integrating the local recovery rate, their visual activities, and individual preferences. The results demonstrated that the thresholds of patients with the same objective examination results might vary widely due to their individual preferences. Therefore, the thresholds are more individualized according to the enhanced Youden's index.
The enhanced Youden's index can establish the optimal-thresholds from the perspective of maximization of patients' net benefit and provide a quantifiable method for shared decision making.
建立一种具有净效益的增强型约登指数，作为共享决策中确定最佳阈值的科学方法。
我们通过将目标函数从准确性最大化改为净效益最大化来重新定义约登指数，并建立了追求患者个体最佳阈值的过程。此外，我们以上海的数据为例，说明了增强型约登指数在白内障手术决策中的应用。
我们修改了决策曲线分析中计算净效益的方法，并将其与约登指数融合，将目的从找到具有最佳检验准确性的阈值扩展到找到具有最佳净效益的阈值。例如，我们使用增强型约登指数为白内障手术决策建立了一个最佳阈值列表。然后，在综合当地恢复率、患者视觉活动和个人偏好后，我们计算了三名虚拟患者各自的阈值。结果表明，具有相同客观检查结果的患者的阈值可能因个人偏好而有很大差异。因此，根据增强型约登指数，阈值更具个性化。
增强型约登指数可以从患者净效益最大化的角度建立最佳阈值，并为共享决策提供一种可量化的方法。
