Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
BMJ Open. 2021 Jan 8;11(1):e040730. doi: 10.1136/bmjopen-2020-040730.
Patients who present in primary care with chronic functional somatic symptoms (FSS) have reduced quality of life and increased health care costs. Recognising these early is a challenge. The aim is to develop and internally validate a clinical prediction rule for repeated consultations with FSS.
Records from the longitudinal population-based ('Lifelines') cohort study were linked to electronic health records from general practitioners (GPs).
We included patients consulting a GP with FSS within 1 year after baseline assessment in the Lifelines cohort.
The outcome is repeated consultations with FSS, defined as ≥3 extra consultations for FSS within 1 year after the first consultation. Multivariable logistic regression, with bootstrapping for internal validation, was used to develop a risk prediction model from 14 literature-based predictors. Model discrimination, calibration and diagnostic accuracy were assessed.
18 810 participants were identified by database linkage, of whom 2650 consulted a GP with FSS and 297 (11%) had ≥3 extra consultations. In the final multivariable model, older age, female sex, lack of healthy activity, presence of generalised anxiety disorder and higher number of GP consultations in the last year predicted repeated consultations. Discrimination after internal validation was 0.64 with a calibration slope of 0.95. The positive predictive value of patients with high scores on the model was 0.37 (0.29-0.47).
Several theoretically suggested predisposing and precipitating predictors, including neuroticism and stressful life events, surprisingly failed to contribute to our final model. Moreover, this model mostly included general predictors of increased risk of repeated consultations among patients with FSS. The model discrimination and positive predictive values were insufficient and preclude clinical implementation.
在初级保健中出现慢性功能性躯体症状（FSS）的患者生活质量降低，医疗保健费用增加。早期识别这些症状具有挑战性。本研究旨在开发和内部验证一种用于 FSS 重复就诊的临床预测规则。
将纵向人群为基础（“Lifelines”）队列研究的记录与全科医生（GP）的电子健康记录相链接。
我们纳入了 Lifelines 队列基线评估后 1 年内因 FSS 就诊 GP 的患者。
结局是 FSS 的重复就诊，定义为首次就诊后 1 年内 FSS 额外就诊≥3 次。使用多变量逻辑回归，并通过自举进行内部验证，从 14 个基于文献的预测因子中开发风险预测模型。评估模型的区分度、校准度和诊断准确性。
通过数据库链接确定了 18810 名参与者，其中 2650 名患者因 FSS 就诊 GP，297 名（11%）患者有≥3 次额外就诊。在最终的多变量模型中，年龄较大、女性、缺乏健康活动、广泛性焦虑障碍和过去 1 年中 GP 就诊次数较多与重复就诊相关。内部验证后的区分度为 0.64，校准斜率为 0.95。模型评分较高的患者阳性预测值为 0.37（0.29-0.47）。
几个理论上认为的易患和诱发因素，包括神经质和压力性生活事件，令人惊讶的是，未能纳入我们的最终模型。此外，该模型主要包括 FSS 患者重复就诊风险增加的一般预测因子。该模型的区分度和阳性预测值不足，不适合临床应用。
