验证 FASD-Tree 作为胎儿酒精谱系障碍的筛查工具。
Validation of the FASD-Tree as a screening tool for fetal alcohol spectrum disorders.
机构信息
Center for Behavioral Teratology and Department of Psychology, San Diego State University, San Diego, California, USA.
Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego, California, USA.
出版信息
Alcohol Clin Exp Res (Hoboken). 2023 Feb;47(2):263-272. doi: 10.1111/acer.14987. Epub 2023 Feb 20.
BACKGROUND
As many as 80% of individuals with fetal alcohol spectrum disorders (FASD) are misdiagnosed or not diagnosed. This study tests the accuracy and validity of a web-based screening tool (the FASD-Tree) for identifying children and adolescents with FASD.
METHODS
Children with histories of prenatal alcohol exposure (PAE) and controls (N = 302, including 224 with PAE and 78 controls) were examined for physical signs of fetal alcohol syndrome (FAS), and parents completed behavioral questionnaires. Data were entered into the FASD-Tree, a web-based decision tree application. The FASD-Tree provided two outcomes: a dichotomous indicator (yes/no) and a numeric risk score (0 to 5), which have been shown separately to identify children with PAE and neurobehavioral impairment and to correlate with neurobehavioral outcomes. Overall accuracy (ACC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the decision tree, risk score, and their combination. Misclassified cases were examined for systematic bias.
RESULTS
The FASD-Tree was successful in accurately identifying youth with histories of PAE and the subgroup of individuals with FASD, indicating its validity as an FASD screening tool. Overall accuracy rates for FASD-Tree components ranged from 75.0% to 84.1%, and both the decision tree outcome and risk score, and their combination, resulted in fair to good discrimination (area under the curve = 0.722 to 0.862) of youth with histories of PAE or FASD. While most participants were correctly classified, those who were misclassified differed in IQ and attention. Race, ethnicity, and sex did not affect the results.
CONCLUSION
The FASD-Tree is not a biomarker of PAE and does not provide definitive evidence of prenatal alcohol exposure. Rather it is an accurate and valid screening tool for FASD and can be used by clinicians who suspect that a patient has a history of PAE, even if the exposure is unknown.
背景
多达 80%的胎儿酒精谱系障碍（FASD）患者被误诊或漏诊。本研究旨在测试一种基于网络的筛查工具（FASD-Tree）识别 FASD 儿童和青少年的准确性和有效性。
方法
对有产前酒精暴露史（PAE）的儿童和对照组（N=302，包括 224 名有 PAE 史的儿童和 78 名对照组儿童）进行检查，以观察其是否有胎儿酒精综合征（FAS）的身体特征，并由家长填写行为问卷。将数据输入基于网络的决策树应用程序 FASD-Tree。FASD-Tree 提供了两个结果：二分类指标（是/否）和数字风险评分（0 至 5），这两个指标已分别被证明可以识别有 PAE 和神经行为障碍的儿童，并与神经行为结果相关。计算决策树、风险评分及其组合的总准确性（ACC）、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。对分类错误的病例进行系统偏差检查。
结果
FASD-Tree 成功准确地识别了有 PAE 史的青少年和 FASD 亚组，表明其作为 FASD 筛查工具的有效性。FASD-Tree 各组成部分的总体准确率范围为 75.0%至 84.1%，决策树结果和风险评分及其组合对有 PAE 史或 FASD 的青少年均具有较好的区分能力（曲线下面积为 0.722 至 0.862）。虽然大多数参与者被正确分类，但那些被错误分类的参与者在智商和注意力方面存在差异。种族、民族和性别并未影响结果。
结论
FASD-Tree 不是 PAE 的生物标志物，也不能提供产前酒精暴露的明确证据。相反，它是一种准确有效的 FASD 筛查工具，可由怀疑患者有 PAE 史的临床医生使用，即使暴露情况未知。
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