Development and performance of a diagnostic/prognostic scoring system for breakthrough pain

Abstract

ObjectivesVariable prevalence and treatment of breakthrough pain (BTP) in different clinical contexts are partially due to the lack of reliable/validated diagnostic tools with prognostic capability. We report the statistical basis and performance analysis of a novel BTP scoring system based on the naïve Bayes classifier (NBC) approach and an 11-item IQ-BTP validated questionnaire. This system aims at classifying potential BTP presence in three likelihood classes: “High,” “Intermediate,” and “Low.”MethodsOut of a training set of n=120 mixed chronic pain patients, predictors associated with the BTP likelihood variables (Pearson’s χ2 and/or Fisher’s exact test) were employed for the NBC planning. Adjusting the binary classification to a three–likelihood classes case enabled the building of a scoring algorithm and to retrieve the score of each predictor’s answer options and the Patient’s Global Score (PGS). The latter medians were used to establish the NBC thresholds, needed to evaluate the scoring system performance (leave-one-out cross-validation).ResultsMedians of PGS in the “High,” “Intermediate,” and “Low” likelihood classes were 3.44, 1.53, and −2.84, respectively. Leading predictors for the model (based on score differences) were flair frequency (ΔS=1.31), duration (ΔS=5.25), and predictability (ΔS=1.17). Percentages of correct classification were 63.6% for the “High” and of 100.0% for either the “Intermediate” and “Low” likelihood classes; overall accuracy of the scoring system was 90.9%.ConclusionThe NBC-based BTP scoring system showed satisfactory performance in classifying potential BTP in three likelihood classes. The reliability, flexibility, and simplicity of this statistical approach may have significant relevance for BTP epidemiology and management. These results need further impact studies to generalize our findings.

The Italian Questionnaire for Cancer Breakthrough Pain Diagnosis, a Multicenter Validation Study

“…The originality of the IQ-BTP questionnaire and its scoring system lies in its prognostic ability [ 18 , 19 ]. It identifies potential-BTcP presence (based on prerequisite elements) and then its risk (based on discriminative elements) as high, intermediate, or low likelihood.…”

“…Discriminative items used by the IQ-BTP to classify the BTcP likelihood are the daily frequency of flairs (< 7/24 h) and the duration of flairs (≤ 30–60 min). Accordingly, among patients who potentially experience BTcP, the latter’s likelihood is high when both the defined discriminative items are present; intermediate if only one is present, and low if none of them are present [ 18 , 19 ].…”

“…In previous publications we have reported the development of a scoring system for a BTP diagnostic/prognostic tool based on an 11-item validated questionnaire (Italian Questionnaire for Breakthrough Pain [IQ-BTP]) [ 18 , 19 ]. This tool enables clinicians to recognize potential-BTP presence using the information collected on BP, ATC opioids medication, EODF, and daily frequency and duration of flairs.…”

“…Following completion of the studies on the initial validation of the IQ-BTP and the performance of its scoring system [ 18 , 19 ], we sought to formally validate this tool in a multicenter cohort of cancer patients, following the COnsensus-based standards to select health Measurement Instruments (COSMIN) taxonomy [ 20 ]. We hypothesized that the IQ-BTP will show satisfactory psychometric and validity properties.…”

¿Tratamos bien el dolor irruptivo?

“…Múltiples autores han propuesto diferentes fórmulas de abordaje del DIO, tomando como referencia el uso de factores pronósticos como la frecuencia de aparición diaria, intensidad o duración del DIO, o bien el uso de formulaciones matemáticas aplicadas a dichos factores (4,5).…”