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首页> 外文期刊>Emerging themes in epidemiology >The validation of a three-stage screening methodology for detecting active convulsive epilepsy in population-based studies in health and demographic surveillance systems
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The validation of a three-stage screening methodology for detecting active convulsive epilepsy in population-based studies in health and demographic surveillance systems

机译：在健康和人口监测系统的基于人群的研究中，用于检测活动性惊厥性癫痫的三阶段筛查方法的验证

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Background There are few studies on the epidemiology of epilepsy in large populations in Low and Middle Income Countries (LMIC). Most studies in these regions use two-stage population-based screening surveys, which are time-consuming and costly to implement in large populations required to generate accurate estimates. We examined the sensitivity and specificity of a three-stage cross-sectional screening methodology in detecting active convulsive epilepsy (ACE), which can be embedded within on-going census of demographic surveillance systems. We validated a three-stage cross-sectional screening methodology on a randomly selected sample of participants of a three-stage prevalence survey of epilepsy. Diagnosis of ACE by an experienced clinician was used as ‘gold standard’. We further compared the expenditure of this method with the standard two-stage methodology. Results We screened 4442 subjects in the validation and identified 35 cases of ACE. Of these, 18 were identified as false negatives, most of whom (15/18) were missed in the first stage and a few (3/18) in the second stage of the three-stage screening. Overall, this methodology had a sensitivity of 48.6% and a specificity of 100%. It was 37% cheaper than a two-stage survey. Conclusion This was the first study to evaluate the performance of a multi-stage screening methodology used to detect epilepsy in demographic surveillance sites. This method had poor sensitivity attributed mainly to stigma-related non-response in the first stage. This method needs to take into consideration the poor sensitivity and the savings in expenditure and time as well as validation in target populations. Our findings suggest the need for continued efforts to develop and improve case-ascertainment methods in population-based epidemiological studies of epilepsy in LMIC.
机译：背景技术在低收入和中等收入国家（LMIC）中，有关大量人群癫痫流行病学的研究很少。这些地区的大多数研究都使用基于人口的两阶段筛查调查，这种调查既耗时又成本高昂，需要大量人口才能生成准确的估算值。我们检查了三阶段横断面筛查方法在检测活动性惊厥性癫痫（ACE）中的敏感性和特异性，该方法可嵌入正在进行的人口普查系统中。我们对癫痫症三阶段患病率调查的参与者的随机选择样本验证了三阶段横截面筛查方法。经验丰富的临床医生对ACE的诊断被用作“黄金标准”。我们进一步将该方法的支出与标准的两阶段方法进行了比较。结果我们筛选了4442名受试者，确认了35例ACE。其中，有18个被识别为假阴性，其中三阶段筛选的第一阶段漏检了大多数（15/18），第二阶段漏检了少数（3/18）。总体而言，该方法的灵敏度为48.6％，特异性为100％。比两阶段调查便宜37％。结论这是第一项评估多阶段筛查方法性能的研究，该方法用于检测人口统计学监测部位的癫痫。该方法的敏感性较差，主要是由于在第一阶段与柱头相关的无反应。这种方法需要考虑到敏感性差，支出和时间节省以及目标人群的验证。我们的发现表明，在LMIC癫痫的基于人群的流行病学研究中，需要继续努力发展和改善病例确定方法。

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