■比较不同弱视筛查测试的性能。
■基于对3295名儿童进行的不同筛查测试的探索性因素分析(EFA),我们在一个矩阵中创建了筛查策略的模型:未矫正视力(UCVA),Plusoptix测量(PO),Randot立体测试(SR),和覆盖测试(CT)。采用受试者工作特征(ROC)曲线和混淆矩阵比较不同模型算法预测弱视新诊断的性能。比较了每个筛查和治疗儿童的估计筛查成本。
■回归分析显示,尽管所有模型都预测弱视(所有p<0.001),仅包含PO或UCVA的模型具有更高的预测能力(R2>0.4)和更好的区分ROC曲线(AUC>0.95;p<0.001).对于96%的灵敏度,UCVA+PO是最具成本效益的模式,由于估计每个接受治疗的儿童的平均筛查费用,如果单独使用PO或UCVA,几乎翻了一番和三倍,分别,而不是使用两种考试。当无法实施UCVA+PO时,将SR添加到UCVA或PO中,可节省28%和18%的成本,分别。
■在先前未筛查的人群中,3-4岁,单独使用UCVA或PO的筛选程序,应该重新考虑同时进行两个测试,因为,为了获得高水平的灵敏度,同时使用UCVA+PO更具成本效益,每次筛选,治疗弱视.应该超越对UCVA+PO组合的耗时更高的考试的担忧,因为每个接受治疗的孩子的费用大幅下降。当儿童从出生以来受益于良好的初级保健常规检查时,在筛查设置中使用CT没有发现获益.SR没有什么好处。
UNASSIGNED: Compare the performance of different amblyopia screening tests.
UNASSIGNED: Based on exploratory factor analyses (EFA) of different screening tests performed in 3295 children, we created models of screening strategies in a matrix with: uncorrected visual acuity (UCVA), Plusoptix measurements (PO), Randot Stereo-test (SR), and Cover-Test (CT). Receiver Operating Characteristic (ROC) curves and confusion matrix were used to compare performance of different model\'s algorithm to predict new diagnosis of amblyopia. Estimated screening costs per screened and treated child were compared.
UNASSIGNED: Regression analyses revealed that, although all models predicted amblyopia (all p < 0.001), only models including PO or UCVA had higher prediction capacity (R2 > 0.4) and better discriminating ROC curves (AUC > 0.95; p < 0.001). For 96% sensitivity, UCVA + PO was the most cost-effective model, since the estimated average screening costs per treated child, almost doubled and tripled if using PO or UCVA alone, respectively, versus using both exams. When UCVA + PO is not possible to implement, adding SR to either UCVA or PO resulted in cost-savings of 28% and 18%, respectively.
UNASSIGNED: In a previous unscreened population, aged 3-4 years, screening programs using either UCVA or PO alone, should reconsider doing both tests simultaneously, since, for a high level of sensitivity, using simultaneously UCVA + PO is more cost-effective, per screened, and treated amblyopia. Concerns relating higher time-consuming exams for the combination of UCVA + PO should be surpassed, since costs per treated child drop considerably. When children benefit from good primary-care routine examinations since birth, no benefit was found for using CT in a screening setting. SR showed little benefit.