Abstract
Background
Early detection could reduce the duration of untreated psychosis. GPs are a vital part of the psychosis care pathway but find it difficult to detect the early features. An accurate risk prediction tool (P Risk) was developed to detect these.
Aim
The external validation of P Risk.
Design and Setting
A retrospective cohort study using a validation dataset of 1,647,934 UK Clinical Practice Research Datalink primary care records linked to secondary care records.
Methods
The same predictors (age, sex, ethnicity, social deprivation, consultations for suicidal behaviour, depression/anxiety and substance abuse, history of consultations for suicidal behaviour, smoking history and substance abuse and prescribed medications for depression/anxiety/PTSD/OCD and total number of consultations) were used as for P Risk development. Predictive risk, sensitivity, specificity, and likelihood ratios were calculated for various risk thresholds. Discrimination (Harrell’s C) and calibration were calculated. Results were compared between the development (GOLD) and validation (AURUM) datasets.
Results
Psychosis risk increased with values of the P Risk prognostic index. Incidence was highest in younger age groups and mainly higher in males. Harrell’s C was 0.79 (95% CI 0.78, 0.79) in the validation dataset and 0.77 in the development dataset. A risk threshold of 1% gave sensitivity of 65.9% and specificity of 86.6%.
Conclusion
Further testing is required but P Risk has the potential to be used in primary care to detect future risk of psychosis.
Early detection could reduce the duration of untreated psychosis. GPs are a vital part of the psychosis care pathway but find it difficult to detect the early features. An accurate risk prediction tool (P Risk) was developed to detect these.
Aim
The external validation of P Risk.
Design and Setting
A retrospective cohort study using a validation dataset of 1,647,934 UK Clinical Practice Research Datalink primary care records linked to secondary care records.
Methods
The same predictors (age, sex, ethnicity, social deprivation, consultations for suicidal behaviour, depression/anxiety and substance abuse, history of consultations for suicidal behaviour, smoking history and substance abuse and prescribed medications for depression/anxiety/PTSD/OCD and total number of consultations) were used as for P Risk development. Predictive risk, sensitivity, specificity, and likelihood ratios were calculated for various risk thresholds. Discrimination (Harrell’s C) and calibration were calculated. Results were compared between the development (GOLD) and validation (AURUM) datasets.
Results
Psychosis risk increased with values of the P Risk prognostic index. Incidence was highest in younger age groups and mainly higher in males. Harrell’s C was 0.79 (95% CI 0.78, 0.79) in the validation dataset and 0.77 in the development dataset. A risk threshold of 1% gave sensitivity of 65.9% and specificity of 86.6%.
Conclusion
Further testing is required but P Risk has the potential to be used in primary care to detect future risk of psychosis.
| Original language | English |
|---|---|
| Article number | BJGP.2024.0017 |
| Pages (from-to) | e854-e860 |
| Number of pages | 7 |
| Journal | British Journal of General Practice |
| Volume | 74 |
| Issue number | 749 |
| Early online date | 14 Oct 2024 |
| DOIs | |
| Publication status | Published - 1 Dec 2024 |
Bibliographical note
Publisher Copyright:©The Authors.
