Sarah A Sullivan, Richard Morris, Daphne Kounali, David Kessler, Willie Hamilton, Glyn Lewis, Philippa Lilford, Irwin Nazareth
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Abstract
Background: Early detection could reduce the duration of untreated psychosis. GPs are a vital part of the psychosis care pathway, but find it difficult to detect the early features. An accurate risk prediction tool, P Risk, was developed to detect these.
Aim: To externally validate P Risk.
Design and setting: This retrospective cohort study used a validation dataset of 1 647 934 UK Clinical Practice Research Datalink (CPRD) primary care records linked to secondary care records.
Method: The same predictors (age; sex; ethnicity; social deprivation; consultations for suicidal behaviour, depression/anxiety, and substance misuse; history of consultations for suicidal behaviour; smoking history; substance misuse; prescribed medications for depression/anxiety/post-traumatic stress disorder/obsessive compulsive disorder; and total number of consultations) were used as for the development of P Risk. Predictive risk, sensitivity, specificity, and likelihood ratios were calculated for various risk thresholds. Discrimination (Harrell's C-index) and calibration were calculated. Results were compared between the development (CPRD GOLD) and validation (CPRD Aurum) datasets.
Results: Psychosis risk increased with values of the P Risk prognostic index. Incidence was highest in younger age groups and, in the main, higher in males. Harrell's C was 0.79 (95% confidence interval = 0.78 to 0.79) in the validation dataset and 0.77 in the development dataset. A risk threshold of 1.0% gave sensitivity of 65.9% and specificity of 86.6%.
Conclusion: Further testing is required, but P Risk has the potential to be used in primary care to detect future risk of psychosis.
背景及早发现可缩短未治疗精神病的持续时间。全科医生是精神病护理路径的重要组成部分，但他们发现很难发现早期特征。我们开发了一种精确的风险预测工具（P Risk）来检测这些特征。目的 对 P Risk 进行外部验证。方法 使用 1,647,934 份英国临床实践研究数据链初级医疗记录与二级医疗记录相连接的验证数据集进行回顾性队列研究。预测因子（年龄、性别、种族、社会贫困程度、自杀行为咨询、抑郁/焦虑和药物滥用、自杀行为咨询史、吸烟史和药物滥用、抑郁/焦虑/创伤后应激障碍/自闭症处方药以及咨询总次数）与 P Risk 的开发相同。计算了各种风险阈值的预测风险、灵敏度、特异性和似然比。计算了辨别率（Harrell's C）和校准率。比较了开发数据集（GOLD）和验证数据集（AURUM）的结果。研究结果 精神病风险随 P 风险预后指数值的增加而增加。年轻群体的发病率最高，主要是男性。验证数据集的 Harrell's C 为 0.79（95% CI 0.78，0.79），开发数据集的 Harrell's C 为 0.77。风险阈值为 1%时，灵敏度为 65.9%，特异度为 86.6%。释义 还需要进一步测试，但 P 风险有可能用于初级保健，以检测未来的精神病风险。
期刊介绍：
The British Journal of General Practice is an international journal publishing research, editorials, debate and analysis, and clinical guidance for family practitioners and primary care researchers worldwide.
BJGP began in 1953 as the ‘College of General Practitioners’ Research Newsletter’, with the ‘Journal of the College of General Practitioners’ first appearing in 1960. Following the change in status of the College, the ‘Journal of the Royal College of General Practitioners’ was launched in 1967. Three editors later, in 1990, the title was changed to the ‘British Journal of General Practice’. The journal is commonly referred to as the ''BJGP'', and is an editorially-independent publication of the Royal College of General Practitioners.
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