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PLoS One. 2017 Sep 28;12(9):e0185560. doi: 10.1371/journal.pone.0185560. eCollection 2017.

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

Author information

1
Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States of America.
2
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
3
Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, United States of America.
4
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
5
Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, United States of America.

Abstract

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.

PMID:
28957445
PMCID:
PMC5619799
DOI:
10.1371/journal.pone.0185560
[Indexed for MEDLINE]
Free PMC Article

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