Use of brain biopsy for diagnostic evaluation of patients with suspected herpes simplex encephalitis: a statistical model and its clinical implications. NIAID Collaborative Antiviral Study Group.
Using the decision analysis technique and multivariate regression methods, a statistical model was established to define the utility of brain biopsy for diagnostic evaluation of patients with suspected herpes simplex encephalitis (HSE). Two strategies were compared: strategy I, brain biopsy with acyclovir (ACV) treatment for 10 days in biopsy-positive patients, and strategy II, ACV therapy without brain biopsy. Strategy I resulted in a greater 6-month survival rate when the likelihood of patients having HSE was less than 70%. Based on the current estimated prevalence of HSE (for patients with suspected HSE) of 35%, strategy I showed a slight advantage of a 3.2% increase in 6-month survival rate. An individual patient's chance of a positive brain biopsy can be predicted using a mathematical equation based on several important clinical assessments. This equation in conjunction with the decision analysis is a useful guide for the clinical management of patients with regard to brain biopsy.
Soong
S J
SJ
Division of Biostatistics, University of Alabama School of Medicine, Birmingham.
Watson
N E
NE
Caddell
G R
GR
Alford
C A
CA
Whitley
R J
RJ
D000212:Acyclovir / Q000627:therapeutic use; D001706:Biopsy; D001921:Brain / Q000473:pathology*; D004660:Encephalitis / Q000175:diagnosis* / Q000188:drug therapy; D006561:Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D015233:Models, Statistical; D015999:Multivariate Analysis; D015995:Prevalence; D011336:Probability; D012044:Regression Analysis
D000212:Acyclovir