Document Detail

Role of skin biopsy to confirm suspected acute graft-vs-host disease: results of decision analysis.
MedLine Citation:
PMID:  16490845     Owner:  NLM     Status:  MEDLINE    
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.
Bahar F Firoz; Stephanie J Lee; Paul Nghiem; Abrar A Qureshi
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  Archives of dermatology     Volume:  142     ISSN:  0003-987X     ISO Abbreviation:  Arch Dermatol     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-21     Completed Date:  2006-03-07     Revised Date:  2008-03-17    
Medline Journal Info:
Nlm Unique ID:  0372433     Medline TA:  Arch Dermatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  175-82     Citation Subset:  AIM; IM    
Department of Dermatology, New York University, New York, USA.
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MeSH Terms
Acute Disease
Decision Support Techniques*
Diagnosis, Differential
Graft vs Host Disease / etiology,  pathology*
Sensitivity and Specificity
Severity of Illness Index
Skin / pathology*
Skin Diseases / etiology,  pathology*
Stem Cell Transplantation / adverse effects

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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