STANDARD ARTICLEDevelopment and internal validation of a prediction tool toaid the diagnosis of Cushing’s syndrome in dogs attendingprimary-care practice

22 de setembro de 2020

Desenvolvimento e validação de ferramenta de no auxilio ao diagnóstico de Chushings (hiperadrenocorticismo) em cães em atendimento pelo veterinário generalista.

Imogen Schofield, David C. Brodbelt, Stijn J. M. Niessen, David B. Church, Rebecca F. Geddes, Noel Kennedy, Dan G. O'Neil.

Abstract

Background: Novel methods to aid identification of dogs with spontaneous Cushing's syndrome are warranted to optimize case selection for diagnostics, avoid unnecessary testing, and ultimately aid decision-making for veterinarians.
Hypothesis/Objectives: To develop and internally validate a prediction tool for dogs receiving a diagnosis of Cushing's syndrome using primary-care electronic health records.
Animals: Three hundred and ninety-eight dogs diagnosed with Cushing's syndrome and 541 non case dogs, tested for but not diagnosed with Cushing's syndrome, from a cohort of 905 544 dogs attending VetCompass participating practices.
Methods: A cross-sectional study design was performed. A prediction model was developed using multivariable binary logistic regression taking the demography, presenting clinical signs and some routine laboratory results into consideration. Predictive performance of each model was assessed and internally validated through bootstrap resampling. A novel clinical prediction tool was developed from the final
model.
Results: The final model included predictor variables sex, age, breed, polydipsia, vomiting, potbelly/hepatomegaly, alopecia, pruritus, alkaline phosphatase, and urine specific gravity. The model demonstrated good discrimination (area under the receiver operating curve [AUROC] = 0.78 [95% CI = 0.75-0.81]; optimism-adjusted AUROC = 0.76) and calibration (C-slope = 0.86). A tool was developed from the
model which calculates the predicted likelihood of a dog having Cushing's syndrome from 0% (score = −13) to 96% (score = 10).
Conclusions and Clinical Importance: A tool to predict a diagnosis of Cushing's syndrome at the point of first suspicion in dogs was developed, with good predictive performance. This tool can be used in practice to support decision-making and increase confidence in diagnosis.

Keywords

Canine, diagnosis, electronic patient record, endocrinology, hyperadrenocorticism, VetCompass

Palavras chaves

Canino, cães, diagnóstico, prontuário eletrônico, endocrinologia, hiperadrenocorticismo, VetCompass

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