Universität zu Köln

Schneider, Antonius, Linde, Klaus ORCID: 0000-0002-2902-970X, Reitsma, Johannes B., Steinhauser, Susanne and Ruecker, Gerta (2017). A novel statistical model for analyzing data of a systematic review generates optimal cutoff values for fractional exhaled nitric oxide for asthma diagnosis. J. Clin. Epidemiol., 92. S. 69 - 79. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1878-5921

Full text not available from this repository.

Abstract

Objectives: Measurement of fractional exhaled nitric oxide (FENO) might substitute bronchial provocation for diagnosing asthma. However, optimal FENO thresholds for diagnosing asthma remain unclear. We reanalyzed data collected for a systematic review investigating the diagnostic accuracy of FENO measurement to exploit all available thresholds under consideration of pretest probabilities using a newly developed statistical model. Study Design and Setting: One hundred and fifty data sets for a total of 53 different cutoffs extracted from 26 studies with 4,518 participants were analyzed with the multiple thresholds model. This model allows identifying thresholds at which the test is likely to perform best. Results: Diagnosing asthma might only be possible in a meaningful manner when the pretest probability of asthma is at least 30%. In that case, FENO > 50 ppb leads to a positive predictive value of 0.76 [95% confidence interval (CI): 0.29-0.96]. Excluding asthma might only be possible, when the pretest probability of asthma is 30% at maximum. Then, FENO < 20 ppb leads to a negative predictive value of 0.86 (95% CI 0.66-0.95). Conclusion: The multiple thresholds model generates a more comprehensive and more clinically useful picture of the effects of different thresholds, which facilitates the determination of optimal thresholds for diagnosing or excluding asthma with FENO measurement. (C) 2017 The Authors. Published by Elsevier Inc.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schneider, Antonius UNSPECIFIED UNSPECIFIED UNSPECIFIED Linde, Klaus UNSPECIFIED orcid.org/0000-0002-2902-970X UNSPECIFIED Reitsma, Johannes B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Steinhauser, Susanne UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruecker, Gerta UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-210206
DOI:	10.1016/j.jclinepi.2017.09.001
Journal or Publication Title:	J. Clin. Epidemiol.
Volume:	92
Page Range:	S. 69 - 79
Date:	2017
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1878-5921
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language SUSPECTED ASTHMA; TEST ACCURACY; MULTIPLE THRESHOLDS; FENO MEASUREMENT; SCREENING TOOL; YOUNG-ADULTS; METAANALYSIS; UTILITY; METHACHOLINE; SPECIFICITY Multiple languages Health Care Sciences & Services; Public, Environmental & Occupational Health Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/21020