Opavsky M A, Stephens D, Wang E E
Division of Infectious Disease, Hospital for Sick Children, Toronto, Ontario.
Arch Pediatr Adolesc Med. 1995 Nov;149(11):1217-20. doi: 10.1001/archpedi.1995.02170240035005.
To determine the sensitivity and specificity of published prognostic models to predict morbidity resulting from lower respiratory tract disease caused by respiratory syncytial virus in an independent pediatric population and to assess the accuracy of single risk factors in predicting adverse outcome.
All articles obtained from a MEDLINE search that used the terms prognosis or sequelae and respiratory syncytial virus, and from the references of these articles, were reviewed. Studies were included if risk factors and outcomes were defined and if information was available in a database of prospectively enrolled patients with respiratory syncytial virus infections. A probability of adverse outcome was assigned to each patient in the cohort using prognostic models described in the articles. A test was considered positive if the probability of the adverse outcome was 5% or more.
Six hundred eighty-nine patients hospitalized with respiratory syncytial virus in seven tertiary care centers across Canada were prospectively enrolled in the Pediatric Investigators Collaborative Network on Infections in Canada database.
The sensitivity and specificity of single predictors and of models in predicting severe disease were determined.
The sensitivity of single predictors varied from 17% to 46%. A model that used age and oxygen saturation at admission in previously well infants had a sensitivity of 98% and a specificity of 47% when predicting intensive care unit admission. Another model that included age at hospitalization, gestational age, presence of an underlying condition, and respiratory syncytial virus subtype used to predict the outcome of a high severity index had a sensitivity of 77% and a specificity of 76%. When the above model was modified by exclusion of viral subgroup, sensitivity increased to 94%, but specificity decreased to 46%.
Previously described prognostic models were generalizable to an independent study population.
确定已发表的预后模型在独立儿科人群中预测呼吸道合胞病毒引起的下呼吸道疾病所致发病率的敏感性和特异性，并评估单一危险因素预测不良结局的准确性。
对通过医学文献数据库检索获得的所有使用“预后”或“后遗症”以及“呼吸道合胞病毒”等术语的文章及其参考文献进行综述。纳入的研究需明确危险因素和结局，且在前瞻性纳入的呼吸道合胞病毒感染患者数据库中可获取相关信息。使用文章中描述的预后模型为队列中的每位患者分配不良结局的概率。若不良结局概率为5%或更高，则该检测被视为阳性。
加拿大七个三级医疗中心的689例因呼吸道合胞病毒住院的患者被前瞻性纳入加拿大儿科感染研究协作网络数据库。
确定单一预测因素和模型在预测严重疾病方面的敏感性和特异性。
单一预测因素的敏感性在17%至46%之间。一个使用既往健康婴儿入院时年龄和血氧饱和度的模型在预测入住重症监护病房时敏感性为98%，特异性为47%。另一个包含住院年龄、胎龄、基础疾病的存在情况以及用于预测高严重指数结局的呼吸道合胞病毒亚型的模型，敏感性为77%，特异性为76%。当通过排除病毒亚组对上述模型进行修正后，敏感性增至94%，但特异性降至46%。
先前描述的预后模型可推广至独立研究人群。
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