University of Porto Faculty of Medicine, Porto, Portugal.
CINTESIS@RISE, Department of Community Medicine, Information and Health Decision25 Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
BMJ Open. 2024 Nov 2;14(11):e086493. doi: 10.1136/bmjopen-2024-086493.
The A2 score is an eight-question patient-reported outcome measure that has been validated for ruling in (score ≥4) and ruling out (score 0-1) asthma. However, this screening tool has been validated in a cohort similar to the derivation cohort used. This study aims to validate the predictive accuracy of the A2 score in a primary care population against general practitioner (GP) clinical assessment and to determine whether the proposed cut-offs are the most appropriate.
This accuracy study is a secondary analysis of the EPI-ASTHMA population-based study.
Primary care centres in Portugal.
Random adult participants answered the A2 score by phone interview.
Those with an A2 score ≥1 (plus 5% with an A2 score of 0) were invited to a diagnostic visit carried out by a GP to confirm or not a diagnosis of asthma. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves.
A total of 1283 participants (median 54 (p25-p75 43-66) years; 60% women) were analysed. The A2 score showed high discriminatory power in identifying asthma, with an area under the ROC curve of 82.9% (95% CI 80.4% to 85.4%). The proposed cut-off ≥4 was the most appropriate to rule in asthma (specificity 83.1%, positive predictive value 62.4%, accuracy 78%). Similarly, the proposed cut-off<2 was the most suitable for excluding asthma (sensitivity 92.7%, negative predictive value 93.7%, accuracy 60.5%).
The A2 score is a useful tool to identify patients with asthma in a primary care population.
NCT0516961.
A2 评分是一种包含八个问题的患者报告结局测量工具，已在临床上验证用于确诊（评分≥4）和排除（评分 0-1）哮喘。然而，该筛查工具仅在与推导队列相似的队列中得到验证。本研究旨在验证 A2 评分在初级保健人群中用于临床医生（GP）评估的预测准确性，并确定所提出的截断值是否最合适。
这是一项基于 EPI-ASTHMA 人群的研究的准确性研究的二次分析。
葡萄牙的基层医疗中心。
随机成年参与者通过电话采访回答 A2 评分。
A2 评分≥1（加上 5%的 A2 评分为 0）的患者被邀请参加由 GP 进行的诊断访问，以确认或排除哮喘诊断。使用接收者操作特征（ROC）曲线评估诊断准确性。
共分析了 1283 名参与者（中位数 54（p25-p75 43-66）岁；60%为女性）。A2 评分在识别哮喘方面具有很高的区分能力，ROC 曲线下面积为 82.9%（95%CI 80.4%至 85.4%）。建议的截断值≥4 最适合用于确诊哮喘（特异性 83.1%，阳性预测值 62.4%，准确性 78%）。同样，建议的截断值<2 最适合用于排除哮喘（敏感性 92.7%，阴性预测值 93.7%，准确性 60.5%）。
A2 评分是一种在初级保健人群中识别哮喘患者的有用工具。
NCT0516961。
