| Role of skin biopsy to confirm suspected acute graft-vs-host disease: results of decision analysis. | |
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MedLine Citation:
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PMID: 16490845 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To estimate the value of skin biopsy in the evaluation of suspected acute cutaneous graft-vs-host disease (GVHD) after allogeneic stem cell transplantation. DESIGN: Decision analysis using parameters specified by expert opinion for skin biopsy characteristics, prevalence of acute GVHD, and value of potential outcomes. One-, 2-, and 3-way sensitivity analyses were performed. SETTING: Major stem cell transplantation centers in the United States. PATIENTS: Hypothetical cohort of patients with suspected acute cutaneous GVHD after stem cell transplantation. INTERVENTIONS: The following 3 interventions were compared: treat immediately for GVHD without performing a skin biopsy, perform a skin biopsy and treat immediately but stop treatment if skin biopsy specimen findings are inconsistent with GVHD, and perform a skin biopsy and await results of the skin biopsy specimen before treating. MAIN OUTCOME MEASURES: Number of patients appropriately and inappropriately treated with each intervention, consistency of physician-reported behavior, individualized decision analyses, and preferred intervention based on the aggregate estimates of respondents. RESULTS: The decision to treat immediately for GVHD without performing a skin biopsy yielded the best clinical outcome for the specified clinical setting and under the parameters specified by expert opinion. One-way sensitivity analyses showed that these conclusions are robust if the prevalence of acute cutaneous GVHD in stem cell recipients with rash is greater than 50%, if the sensitivity of skin biopsy specimen is less than 0.8, and the specificity of skin biopsy specimen is less than 0.9. Only 25% of physicians interviewed chose an intervention consistent with their estimates of prevalence, test characteristics, and outcome evaluations, indicating an opportunity to improve management of this important clinical condition. CONCLUSIONS: This decision analysis modeling technique predicts that in patient populations in which the prevalence of GVHD is 30% or greater (typical for allogeneic stem cell transplantation), the best outcomes were obtained with treatment for GVHD and no skin biopsy. In populations with prevalence of GVHD of 30% or less, obtaining a skin biopsy specimen to guide treatment was predicted to provide the best patient outcomes. |
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Authors:
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Bahar F Firoz; Stephanie J Lee; Paul Nghiem; Abrar A Qureshi |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study |
Journal Detail:
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Title: Archives of dermatology Volume: 142 ISSN: 0003-987X ISO Abbreviation: Arch Dermatol Publication Date: 2006 Feb |
Date Detail:
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Created Date: 2006-02-21 Completed Date: 2006-03-07 Revised Date: 2008-03-17 |
Medline Journal Info:
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Nlm Unique ID: 0372433 Medline TA: Arch Dermatol Country: United States |
Other Details:
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Languages: eng Pagination: 175-82 Citation Subset: AIM; IM |
Affiliation:
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Department of Dermatology, New York University, New York, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Biopsy Decision Support Techniques* Diagnosis, Differential Graft vs Host Disease / etiology, pathology* Humans Prognosis Questionnaires Sensitivity and Specificity Severity of Illness Index Skin / pathology* Skin Diseases / etiology, pathology* Stem Cell Transplantation / adverse effects |
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