开发以专家为基础的评分系统,用于早期识别基层医疗机构中的先天性免疫错误患者--PIDCAP 项目。

IF 7.2 2区 医学 Q1 IMMUNOLOGY Journal of Clinical Immunology Pub Date : 2024-10-21 DOI:10.1007/s10875-024-01825-3
Jacques G Rivière, Gerard Carot-Sans, Jordi Piera-Jiménez, Sergi de la Torre, Xavier Cos, Xavier Serra-Picamal, Pere Soler-Palacin
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引用次数: 0

摘要

事实证明,早期诊断先天性免疫错误(IEIs)可降低死亡率、发病率和医疗成本。对早期诊断的需求促使人们开发计算工具,以引发医生更早地进行临床怀疑。初级保健专业人员是改善早期诊断的第一线。为此,我们开发了一种基于计算机的工具(基于扩展的杰弗里-莫德尔基金会(JMF)预警信号),以协助医生在初级医疗环境中对 IEI 做出诊断决定。在专家指导下开发了两个评分系统(一个是儿童评分系统,一个是成人评分系统)。由 36 位专家组成的小组就哪些征兆应包括在内以及如何权衡这些征兆达成了共识。根据使用初级保健电子病历对确诊 IEI 患者进行的回顾性登记,对由此产生的评分系统进行了测试。还进行了一项试点研究,以评估在初级保健中实施该系统的可行性。该评分系统包括针对儿科患者的 27 个警告标志和针对成人的 24 个警告标志,并在 JMF 警告标志的基础上增加了专家共识确立的临床相关标准。细胞减少症、≥ 2 次全身感染、反复发热和支气管扩张是儿童的主要预警信号,支气管扩张、自身免疫性疾病、细胞减少症和> 3 次肺炎也是成人的主要预警信号。在一个试点地区的初级保健工作站中采用了 PIDCAP(初级免疫缺陷 "Centre d'Atenció Primària",在加泰罗尼亚语中代表初级保健中心)工具。这种以专家为基础的方法有可能减少 IEI 的漏报和诊断延误。它可以无缝集成到临床初级保健工作站中。
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Development of an Expert-Based Scoring System for Early Identification of Patients with Inborn Errors of Immunity in Primary Care Settings - the PIDCAP Project.

Early diagnosis of inborn errors of immunity (IEIs) has been shown to reduce mortality, morbidity, and healthcare costs. The need for early diagnosis has led to the development of computational tools that trigger earlier clinical suspicion by physicians. Primary care professionals serve as the first line for improving early diagnosis. To this end, a computer-based tool (based on extended Jeffrey Modell Foundation (JMF) Warning Signs) was developed to assist physicians with diagnosis decisions for IEIs in the primary care setting. Two expert-guided scoring systems (one pediatric, one adult) were developed. IEI warning signs were identified and a panel of 36 experts reached a consensus on which signs to include and how they should be weighted. The resulting scoring system was tested against a retrospective registry of patients with confirmed IEI using primary care EHRs. A pilot study to assess the feasibility of implementation in primary care was conducted. The scoring system includes 27 warning signs for pediatric patients and 24 for adults, adding additional clinically relevant criteria established by expert consensus to the JMF Warning Signs. Cytopenias, ≥ 2 systemic infections, recurrent fever and bronchiectasis were the leading warning signs in children, as bronchiectasis, autoimmune diseases, cytopenias, and > 3 pneumonias were in adults. The PIDCAP (Primary Immune Deficiency "Centre d'Atenció Primària" that stands for Primary Care Center in Catalan) tool was implemented in the primary care workstation in a pilot area. The expert-based approach has the potential to lessen under-reporting and minimize diagnostic delays of IEIs. It can be seamlessly integrated into clinical primary care workstations.

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来源期刊
CiteScore
12.20
自引率
9.90%
发文量
218
审稿时长
2 months
期刊介绍: The Journal of Clinical Immunology publishes impactful papers in the realm of human immunology, delving into the diagnosis, pathogenesis, prognosis, or treatment of human diseases. The journal places particular emphasis on primary immunodeficiencies and related diseases, encompassing inborn errors of immunity in a broad sense, their underlying genotypes, and diverse phenotypes. These phenotypes include infection, malignancy, allergy, auto-inflammation, and autoimmunity. We welcome a broad spectrum of studies in this domain, spanning genetic discovery, clinical description, immunologic assessment, diagnostic approaches, prognosis evaluation, and treatment interventions. Case reports are considered if they are genuinely original and accompanied by a concise review of the relevant medical literature, illustrating how the novel case study advances the field. The instructions to authors provide detailed guidance on the four categories of papers accepted by the journal.
期刊最新文献
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