Error simulation modeling to assess the effects of bias and precision on bilirubin measurements used to screen for neonatal hyperbilirubinemia
| Autor: | Jose Jara Aguirre, Andrew P. Norgan, Brad S. Karon, Walter J. Cook |
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| Rok vydání: | 2021 |
| Předmět: |
030213 general clinical medicine
Percentile Bilirubin Coefficient of variation Clinical Biochemistry Risk Assessment Sensitivity and Specificity Risk zone Serum bilirubin 03 medical and health sciences chemistry.chemical_compound Neonatal Screening 0302 clinical medicine Bias Predictive Value of Tests 030225 pediatrics Statistics Humans High risk infants Mathematics Transcutaneous bilirubin Biochemistry (medical) Infant Newborn Infant General Medicine Negative bias chemistry Hyperbilirubinemia Neonatal |
| Zdroj: | Clinical Chemistry and Laboratory Medicine (CCLM). 59:1069-1075 |
| ISSN: | 1437-4331 1434-6621 |
| DOI: | 10.1515/cclm-2020-1640 |
| Popis: | Objectives Error simulation models have been used to understand the relationship between analytical performance and clinical outcomes. We developed an error simulation model to understand the effects of method bias and precision on misclassification rate for neonatal hyperbilirubinemia using an age-adjusted risk assessment tool. Methods For each of 176 measured total bilirubin (TSBM) values, 10,000 simulated total bilirubin (TBS) values were generated at each combination of bias and precision conditions for coefficient of variation (CV) between 1 and 15%, and for biases between −51.3 μmol/L and 51.3 μmol/L (−3 and 3 mg/dL) fixed bias. TBS values were analyzed to determine if they were in the same risk zone as the TSBM value. We then calculated sensitivity and specificity for prediction of ≥75th percentile for postnatal age values as a function of assay bias and precision, and determined the rate of critical errors (≥95th percentile for age TSBM with S). Results A sensitivity >95% for predicting ≥75th percentile bilirubin values was observed when there is a positive fixed bias of greater than 17.1 μmol/L (1.0 mg/dL) and CV is maintained ≤10%. A specificity >70% for predicting 0.2% until negative bias was −17.1 μmol/L (−1 mg/dL) or lower. Conclusions A positive systematic bias of 17.1 μmol/L (1 mg/dL) may be optimal for balancing sensitivity and specificity for predicting ≥75th percentile TSB values. Negative systematic bias should be avoided to allow detection of high risk infants and avoid critical classification errors. |
| Databáze: | OpenAIRE |
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