Haider Sajjad, Sadiq Salman Naveed, Lufumpa Eniya, Sihre Harpreet, Tallouzi Mohammad, Moore David J, Nirantharakumar Krishnarajah, Price Malcolm James
University of Birmingham, Birmingham, UK.
Ophthalmology, Royal Victoria Infirmary, Newcastle, UK.
BMJ Open Ophthalmol. 2020 Oct 9;5(1):e000579. doi: 10.1136/bmjophth-2020-000579. eCollection 2020.
Risk stratification is needed for patients referred to hospital eye services by Diabetic Eye Screening Programme UK. This requires a set of candidate predictors. The literature contains a large number of predictors. The objective of this research was to arrive at a small set of clinically important predictors for the outcome of the progression of diabetic retinopathy (DR). They need to be evidence based and readily available during the clinical consultation.
Initial list of predictors was obtained from a systematic review of prediction models. We sought the clinical expert opinion using a formal qualitative study design. A series of nominal group technique meetings to shorten the list and to rank the predictors for importance by voting were held with National Health Service hospital-based clinicians involved in caring for patients with DR in the UK. We then evaluated the evidence base for the selected predictors by critically appraising the evidence.
The source list was presented at nominal group meetings (n=4), attended by 44 clinicians. Twenty-five predictors from the original list were ranked as important predictors and eight new predictors were proposed. Two additional predictors were retained after evidence check. Of these 35, 21 had robust supporting evidence in the literature condensed into a set of 19 predictors by categorising DR.
We identified a set of 19 clinically meaningful predictors of DR progression that can help stratify higher-risk patients referred to hospital eye services and should be considered in the development of an individual risk stratification model.
A qualitative study and evidence review.
Secondary eye care centres in North East, Midlands and South of England.
英国糖尿病眼病筛查项目转诊至医院眼科服务的患者需要进行风险分层。这需要一组候选预测指标。文献中包含大量预测指标。本研究的目的是得出一小套对糖尿病视网膜病变（DR）进展结果具有临床重要意义的预测指标。它们需要基于证据，并且在临床会诊期间易于获取。
预测指标的初始列表来自对预测模型的系统评价。我们采用正式的定性研究设计寻求临床专家意见。与英国参与照顾DR患者的国民保健服务（NHS）医院临床医生举行了一系列名义小组技术会议，以缩短列表并通过投票对预测指标的重要性进行排序。然后，我们通过严格评估证据来评估所选预测指标的证据基础。
源列表在名义小组会议（n = 4）上展示，44名临床医生参加。原始列表中的25个预测指标被列为重要预测指标，并提出了8个新的预测指标。在证据核查后保留了另外2个预测指标。在这35个指标中，21个在文献中有有力的支持证据，通过对DR进行分类浓缩为一组19个预测指标。
我们确定了一组19个对DR进展具有临床意义的预测指标，这些指标有助于对转诊至医院眼科服务的高风险患者进行分层，并且在开发个体风险分层模型时应予以考虑。
定性研究和证据综述。
英格兰东北部、中部地区和南部的二级眼科护理中心。
