Royal Hospital for Sick Children, Edinburgh, UK.
Royal Infirmary of Edinburgh, Edinburgh, UK.
Bone Joint J. 2022 May;104-B(5):640-644. doi: 10.1302/0301-620X.104B5.BJJ-2021-0301.R5.
The Uppföljningsprogram för cerebral pares (CPUP) Hip Score distinguishes between children with cerebral palsy (CP) at different levels of risk for displacement of the hip. The score was constructed using data from Swedish children with CP, but has not been confirmed in any other population. The aim of this study was to determine the calibration and discriminatory accuracy of this score in children with CP in Scotland.
This was a total population-based study of children registered with the Cerebral Palsy Integrated Pathway Scotland. Displacement of the hip was defined as a migration percentage (MP) of > 40%. Inclusion criteria were children in Gross Motor Function Classification System (GMFCS) levels III to V. The calibration slope was estimated and Kaplan-Meier curves produced for five strata of CPUP scores to compare the observed with the predicted risk of displacement of the hip at five years. For discriminatory accuracy, the time-dependent area under the receiver operating characteristic curve (AUC) was estimated. In order to analyze differences in the performance of the score between cohorts, score weights, and subsequently the AUC, were re-estimated using the variables of the original score: the child's age at the first examination, GMFCS level, head shaft angle, and MP of the worst hip in a logistic regression with imputation of outcomes for those with incomplete follow-up.
The discriminatory accuracy of the score in the new population of 367 children was high (AUC 0.78 (95% confidence interval (CI) 0.71 to 0.86)). The calibration of the score was insufficient (slope 0.48 (95% CI 0.31 to 0.65)), and the absolute risks of displacement of the hip in this population were overestimated. The AUC increased with re-estimated weights (0.85 (95% CI 0.79 to 0.91)).
The CPUP Hip Score had a high ability to discriminate between children at different levels of risk for displacement of the hip. The score overestimated the absolute risks of displacement in this population, which may have resulted from differences in the way children were initially registered in the two programmes. The results are promising, but the score weights may need re-estimation before its clinical application in Scotland. Cite this article: 2022;104-B(5):640-644.
Uppföljningsprogram för cerebral pares (CPUP) Hip Score 可区分不同风险水平的脑瘫儿童髋关节位移。该评分使用瑞典脑瘫儿童的数据构建，但尚未在其他人群中得到验证。本研究旨在确定该评分在苏格兰脑瘫儿童中的校准和判别准确性。
这是一项基于全人群的苏格兰脑瘫综合途径登记儿童研究。髋关节位移定义为迁移百分比（MP）>40%。纳入标准为 Gross Motor Function Classification System (GMFCS) 水平 III 至 V 的儿童。估计校准斜率并生成 CPUP 评分的五个分层的 Kaplan-Meier 曲线，以比较五年时髋关节位移的观察风险与预测风险。为了评估判别准确性，估计时间依赖性接收器操作特征曲线下面积（AUC）。为了分析评分在两个队列中的性能差异，使用原始评分的变量（儿童首次检查时的年龄、GMFCS 水平、头干角和最差髋关节的 MP）在逻辑回归中重新估计评分权重，随后重新估计 AUC，并对随访不完整的结果进行插补。
在新的 367 名儿童队列中，评分的判别准确性较高（AUC 为 0.78（95%置信区间 0.71 至 0.86））。评分的校准不足（斜率为 0.48（95%置信区间 0.31 至 0.65）），并且该人群中髋关节位移的绝对风险被高估。重新估计权重后 AUC 增加（0.85（95%置信区间 0.79 至 0.91））。
CPUP Hip Score 能够很好地区分髋关节位移风险水平不同的儿童。评分高估了该人群中髋关节位移的绝对风险，这可能是由于两个方案中儿童最初登记方式的差异所致。结果令人鼓舞，但在苏格兰临床应用之前，可能需要重新估计评分权重。引用本文：2022；104-B(5):640-644.
