Starmans R, Muris J W, Fijten G H, Schouten H J, Pop P, Knottnerus J A
Department of General Practice, University of Limburg, Maastricht, The Netherlands.
Med Decis Making. 1994 Jul-Sep;14(3):208-16. doi: 10.1177/0272989X9401400302.
Scoring models based on history and physical examination have been developed to discriminate patients with non-organic gastrointestinal disease from those who have organic disease. The application of these models may lead to more efficient diagnosis and prevent somatization. Although the models have high diagnostic accuracy in the population in which they have been developed, their value in other populations has not been established. In this study previously developed models were tested in validation populations defined by the original selection criteria from the studies in which the models were developed and in unselected general practice and outpatient populations. The diagnostic performance of the models are expressed in terms of odds ratio and sensitivity and specificity for the classification of patients as having organic and non-organic disease. The diagnostic performance of all the models were rather low in the validation populations. Relatively few elements of the models had independent diagnostic value. In addition, the correlation between the scoring models, expressed in Cohen's kappa, was extremely low. The diagnostic values of the scoring models were not reproduced in comparable and unselected populations. Therefore, it is concluded that the diagnostic value of such a model has little external validity.
基于病史和体格检查的评分模型已被开发出来，用于区分患有非器质性胃肠疾病的患者和患有器质性疾病的患者。这些模型的应用可能会提高诊断效率并防止躯体化。尽管这些模型在所开发的人群中具有较高的诊断准确性，但其在其他人群中的价值尚未确定。在本研究中，先前开发的模型在由模型开发研究中的原始选择标准定义的验证人群以及未经过选择的全科医疗和门诊人群中进行了测试。模型的诊断性能以比值比、敏感性和特异性来表示，用于将患者分类为患有器质性疾病和非器质性疾病。在验证人群中，所有模型的诊断性能都相当低。模型中相对较少的因素具有独立的诊断价值。此外，以科恩kappa系数表示的评分模型之间的相关性极低。评分模型的诊断价值在可比的未经过选择的人群中未得到重现。因此，得出的结论是，这样一个模型的诊断价值几乎没有外部效度。
