Transcript Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in

Royal College of Surgeons in Ireland
Coláiste Ríoga na Máinleá in Éirinn
Diagnostic accuracy of the ID-Migraine: a systematic
review and meta-analysis
Rose Galvin, Gráinne Cousins, Samira Hijazze , Floris Van de Laar and Tom Fahey
Division of Population Health Sciences
Outline
• Background and study aims
• Methods
• Results
• Conclusion
Division of Population Health Sciences
Background
• Migraine is a common disorder
– 18% women
– 6-8% men
• Despite the prevalence and burden of migraine
– <50% of patients receive a medical diagnosis
– 1/3 receive migraine specific prescription medications
Division of Population Health Sciences
Background
• Diagnosis is challenging
– 1988/2004: International Headache Society (IHS)
developed a comprehensive headache classification
system
– too cumbersome for GPs to apply
• Symptom complex
– unlikely any one symptom is sufficient to rule in/out
condition
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Background
• 3 item ID Migraine
– brief, self-administered clinical prediction rule for adults
• photophobia
• nausea
• Disability
– Positive score if patient endorses 2 of the 3 items
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Study Aim
Peform a comprehensive systematic review and metaanalysis of validation studies of the ID migraine to
determine its diagnostic accuracy as a decision rule for
identifying patients with migraine
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Method
Inclusion criteria:
1. Validate ID Migraine - IHS criteria as reference standard
2. Cohort or cross-sectional design
3. Sufficient data to calculate
– Sensitivity
– Specificity
– Negative and positive predictive values
– Prevalence of migraine
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Method
•
Quality assessment (QUADAS)
– Risk of spectrum bias
– primary care/ headache clinic/ neurology department/
TMJ & pain clinic/ dental clinic/ ENT/ workplace/
school
•
Meta-analysis: Bivariate random effects model
– Sensitivity analysis
•
•
Representative patient groups
Primary care; neurology departments; headache clinics
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Results
•
11 articles (13 studies)
– N=5,866
– Mean weighted prior probability of migraine - 59%
•
Representative patient group (6 studies)
– N=3,142
– Mean weighted prior probability of migraine - 60%
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Results: All studies
All Studies
(n=13)
Sensitivity
95% CI
Specificity
95% CI
+ LR
95% CI
- LR
95% CI
0.84
(0.75-0.90)
0.76
(0.69-0.83)
3.55
(2.76-4.57)
0.21
(0.14-0.32)
Positive score:
59% to 84%
Negative score:
59% to 23%
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Results: Sensitivity analysis
Representative
patient groups
(n=6)
Sensitivity
95% CI
Specificity
95% CI
+ LR
95% CI
- LR
95% CI
0.88
(0.75-0.93)
0.71
(0.63-0.78)
2.99
(2.45-3.60)
0.17
(0.11-0.33)
Positive score:
60% to 82%
Negative score:
60% to 21%
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Conclusions
• Useful tool to rule out migraine
• Sensitivity analysis
– Support generalisability of overall study findings
• Limitations
– Gender differences unclear
– High pre-test probability in included studies
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Conclusions
• Positive score
– Prescribe migraine specific medication
– Monitor response to treatment
• Negative score
– Greater certainty patient doesn’t have migraine
– Consider alternative diagnosis
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