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Development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates

OBJECTIVE: The adenoma detection rate (ADR) varies widely between physicians, possibly due to patient population differences, hampering direct ADR comparison. We developed and validated a prediction model for adenoma detection in an effort to determine if physicians’ ADRs should be adjusted for pati...

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Autores principales: Brand, Eelco C., Crook, Julia E., Thomas, Colleen S., Siersema, Peter D., Rex, Douglas K., Wallace, Michael B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5619799/
https://www.ncbi.nlm.nih.gov/pubmed/28957445
http://dx.doi.org/10.1371/journal.pone.0185560
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author Brand, Eelco C.
Crook, Julia E.
Thomas, Colleen S.
Siersema, Peter D.
Rex, Douglas K.
Wallace, Michael B.
author_facet Brand, Eelco C.
Crook, Julia E.
Thomas, Colleen S.
Siersema, Peter D.
Rex, Douglas K.
Wallace, Michael B.
author_sort Brand, Eelco C.
collection PubMed
description OBJECTIVE: The adenoma detection rate (ADR) varies widely between physicians, possibly due to patient population differences, hampering direct ADR comparison. We developed and validated a prediction model for adenoma detection in an effort to determine if physicians’ ADRs should be adjusted for patient-related factors. MATERIALS AND METHODS: Screening and surveillance colonoscopy data from the cross-sectional multicenter cluster-randomized Endoscopic Quality Improvement Program-3 (EQUIP-3) study (NCT02325635) was used. The dataset was split into two cohorts based on center. A prediction model for detection of ≥1 adenoma was developed using multivariable logistic regression and subsequently internally (bootstrap resampling) and geographically validated. We compared predicted to observed ADRs. RESULTS: The derivation (5 centers, 35 physicians, overall-ADR: 36%) and validation (4 centers, 31 physicians, overall-ADR: 40%) cohort included respectively 9934 and 10034 patients (both cohorts: 48% male, median age 60 years). Independent predictors for detection of ≥1 adenoma were: age (optimism-corrected odds ratio (OR): 1.02; 95%-confidence interval (CI): 1.02–1.03), male sex (OR: 1.73; 95%-CI: 1.60–1.88), body mass index (OR: 1.02; 95%-CI: 1.01–1.03), American Society of Anesthesiology physical status class (OR class II vs. I: 1.29; 95%-CI: 1.17–1.43, OR class ≥III vs. I: 1.57; 95%-CI: 1.32–1.86), surveillance versus screening (OR: 1.39; 95%-CI: 1.27–1.53), and Hispanic or Latino ethnicity (OR: 1.13; 95%-CI: 1.00–1.27). The model’s discriminative ability was modest (C-statistic in the derivation: 0.63 and validation cohort: 0.60). The observed ADR was considerably lower than predicted for 12/66 (18.2%) physicians and 2/9 (22.2%) centers, and considerably higher than predicted for 18/66 (27.3%) physicians and 4/9 (44.4%) centers. CONCLUSION: The substantial variation in ADRs could only partially be explained by patient-related factors. These data suggest that ADR variation could likely also be due to other factors, e.g. physician or technical issues.
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spelling pubmed-56197992017-10-17 Development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates Brand, Eelco C. Crook, Julia E. Thomas, Colleen S. Siersema, Peter D. Rex, Douglas K. Wallace, Michael B. PLoS One Research Article OBJECTIVE: The adenoma detection rate (ADR) varies widely between physicians, possibly due to patient population differences, hampering direct ADR comparison. We developed and validated a prediction model for adenoma detection in an effort to determine if physicians’ ADRs should be adjusted for patient-related factors. MATERIALS AND METHODS: Screening and surveillance colonoscopy data from the cross-sectional multicenter cluster-randomized Endoscopic Quality Improvement Program-3 (EQUIP-3) study (NCT02325635) was used. The dataset was split into two cohorts based on center. A prediction model for detection of ≥1 adenoma was developed using multivariable logistic regression and subsequently internally (bootstrap resampling) and geographically validated. We compared predicted to observed ADRs. RESULTS: The derivation (5 centers, 35 physicians, overall-ADR: 36%) and validation (4 centers, 31 physicians, overall-ADR: 40%) cohort included respectively 9934 and 10034 patients (both cohorts: 48% male, median age 60 years). Independent predictors for detection of ≥1 adenoma were: age (optimism-corrected odds ratio (OR): 1.02; 95%-confidence interval (CI): 1.02–1.03), male sex (OR: 1.73; 95%-CI: 1.60–1.88), body mass index (OR: 1.02; 95%-CI: 1.01–1.03), American Society of Anesthesiology physical status class (OR class II vs. I: 1.29; 95%-CI: 1.17–1.43, OR class ≥III vs. I: 1.57; 95%-CI: 1.32–1.86), surveillance versus screening (OR: 1.39; 95%-CI: 1.27–1.53), and Hispanic or Latino ethnicity (OR: 1.13; 95%-CI: 1.00–1.27). The model’s discriminative ability was modest (C-statistic in the derivation: 0.63 and validation cohort: 0.60). The observed ADR was considerably lower than predicted for 12/66 (18.2%) physicians and 2/9 (22.2%) centers, and considerably higher than predicted for 18/66 (27.3%) physicians and 4/9 (44.4%) centers. CONCLUSION: The substantial variation in ADRs could only partially be explained by patient-related factors. These data suggest that ADR variation could likely also be due to other factors, e.g. physician or technical issues. Public Library of Science 2017-09-28 /pmc/articles/PMC5619799/ /pubmed/28957445 http://dx.doi.org/10.1371/journal.pone.0185560 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Brand, Eelco C.
Crook, Julia E.
Thomas, Colleen S.
Siersema, Peter D.
Rex, Douglas K.
Wallace, Michael B.
Development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates
title Development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates
title_full Development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates
title_fullStr Development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates
title_full_unstemmed Development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates
title_short Development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates
title_sort development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5619799/
https://www.ncbi.nlm.nih.gov/pubmed/28957445
http://dx.doi.org/10.1371/journal.pone.0185560
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