title: 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.
abstract: 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.
authors.affiliation: Division of Biostatistics, University of Alabama School of Medicine, Birmingham.
authors.forename: S J
authors.initials: SJ
authors.lastname: Soong
authors.forename: N E
authors.initials: NE
authors.lastname: Watson
authors.forename: G R
authors.initials: GR
authors.lastname: Caddell
authors.forename: C A
authors.initials: CA
authors.lastname: Alford
authors.forename: R J
authors.initials: RJ
authors.lastname: Whitley
mesh_terms: 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
chemical_list: D000212:Acyclovir