Paul C. Schroy|John B. Wong|Michael J. O?Brien|Clara A. Chen|John L. Griffith
A Risk Prediction Index for Advanced Colorectal Neoplasia at Screening Colonoscopy
Boston Medical Center|Boston University|Tufts Medical Center|Boston University|Boston University|Northeastern University
eliciting patient preferences within context shared decision making advocated colorectal cancer screening risk stratification advanced colorectal neoplasia acn might facilitate effective shared decision making selecting appropriate screening option objective develop validate clinical index estimating probability acn screening colonoscopywe conducted crosssectional analysis 3543 asymptomatic mostly averagerisk patients 5079 years age undergoing screening colonoscopy two urban safety net hospitals predictors acn identified using multiple logistic regression model performance internally validated using bootstrapping methodsthe final index consisted five independent predictors risk age smoking alcohol intake height combined sexraceethnicity variable smoking strongest predictor net reclassification improvement nri 84 height weakest nri 15 using simplified weighted scoring system based 05 increments adjusted odds ratio risk acn ranged 32 95 confidence interval ci 2639 lowrisk group score 2 86 95 ci 7497 intermediatehighrisk group score 311 model moderate good overall discrimination cstatistic 069 95 ci 066072 good calibration p073093a simple 5item risk index based readily available clinical data accurately stratifies averagerisk patients low intermediatehighrisk categories acn screening colonoscopy uptake clinical practice could facilitate effective shared decisionmaking crc screening particularly situations patient provider test preferences differ