title: Is it primary neuropsychiatric systemic lupus erythematosus? Performance of existing attribution models using physician judgment as the gold standard.
abstract: OBJECTIVE
  Models for the attribution of neuropsychiatric manifestations to systemic lupus erythematosus (NPSLE) that incorporate timing and type of manifestation, exclusion/confounding or favouring factors have been proposed. We tested their diagnostic performance against expert physician judgment.
  
  
  METHODS
  SLE patients with neuropsychiatric manifestations were identified through retrospective chart review. Manifestations were classified according to physician judgment as attributed to SLE, not attributed or uncertain. Results were compared against the Systemic Lupus International Collaborating Clinics (SLICC) attribution models A and B, and one introduced by the Italian Study Group on NPSLE.
  
  
  RESULTS
  191 patients experienced a total 242 neuropsychiatric manifestations, 136 of which were attributed to SLE according to physician. Both SLICC models showed high specificity (96.2% and 79.2% for model A and B, respectively) but low sensitivity (22.8% and 34.6%, respectively) against physician judgment. Exclusion of cases of headache, anxiety disorders, mild mood and cognitive disorders and polyneuropathy without electrophysiologic confirmation led to modest increases in sensitivity (27.7% and 42.0% for SLICC models A and B, respectively) and reductions in specificity (94.8% and 65.5%, respectively). The Italian Group model showed good accuracy in NPSLE attribution with an area under the curve of the receiver operating characteristics analysis of 0.862; values ≥7 showed the best combination of sensitivity and specificity (82.4% and 82.9%, respectively).
  
  
  CONCLUSIONS
  Attribution models can be useful in NPSLE diagnosis in routine clinical practice and their performance is superior in major neuropsychiatric manifestations. The Italian Study Group model is accurate, with values ≥7 showing the best combination of sensitivity and specificity.
authors.affiliation: Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion; and Institute of Molecular Biology and Biotechnology, Foundation of Research and Technology-Hellas, Voutes, Heraklion, Greece. afanouriakis@edu.med.uoc.gr.
authors.forename: Antonis
authors.initials: A
authors.lastname: Fanouriakis
authors.affiliation: Department of Rheumatology, 'Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Cristina
authors.initials: C
authors.lastname: Pamfil
authors.affiliation: Department of Rheumatology, 'Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Rednic
authors.affiliation: Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.
authors.forename: Prodromos
authors.initials: P
authors.lastname: Sidiropoulos
authors.affiliation: Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion; and Institute of Molecular Biology and Biotechnology, Foundation of Research and Technology-Hellas, Voutes, Heraklion, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Bertsias
authors.affiliation: Inst.Mol.Biology & Biotechnology, Found.Research and Technology-Hellas, Heraklion; Lab.Autoimmunity and Inflammation, Biomedical Res.Found. Academy of Athens; 4th Dept.of Int.Medicine,"Attikon" Univ.Hosp., National and Kapodestrian Univ. Athens, Greece.
authors.forename: Dimitrios T
authors.initials: DT
authors.lastname: Boumpas
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003661:Decision Support Techniques; D005260:Female; D006115:Greece; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007600:Judgment; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D020945:Lupus Vasculitis, Central Nervous System / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012383:Romania; D055815:Young Adult