Revision And Evaluation Of Early Magnetic Resonance Rating Scale For Post-stroke Depression

Objective: In order improve the clinical diagnosis and treatment rate of PSD,we revised the clinical magnetic resonance score early warning scale,and carried out the risk stratification of the score,improved the accuracy of the scale identifying the PSD.Evaluated the validity and reliability of the new scale.Methods: A total of 440 patients with acute ischemic stroke who were hospitalized from Department of Neurology,the First Hospital of Jilin University from June to February 2017 were collected and randomly divided into two groups: the derivation group and the validation group.Record the general information on the sex,age,education and other subjects of the patients,as well as the risk factors of cerebrovascular disease such as smoking,alcoholism,hypertension,diabetes mellitus.The Hamilton Depression Scale was scored on the two groups,and were divided into PSD group and non-PSD group according the scores.The patients in the induction group were scored using the original scale,calculated the Pearson’s coefficients and the distribution characteristics of each item in PSD and non-PSD group.The actuality of occurring PSD in each project was calculated.Comparing the results of the above,new scales of 7 different combinations was obtained.Seven new scales were used to evaluate the inductiongroup.The Cronbach ’α coefficients of each scale were compared and analyzed under the ROC curve(AUC)as well as distinguishing validity,selecting the best combination as the revised scale.The optimal diagnostic value of the revised scale was selected by calculating the maximum Youden index,as well as the sensitivity and specificity of the scale indentifying the PSD.According the incidence rate of PSD in patients with different score,analyze the risk stratification of the scale score.Using the revised scale and the original scale to evaluate the validation group,analyze the area of the ROC curve of the revised scale and the original scale,and the distribution of the population was analyzed to verify whether the risk stratification was reasonable.The PSD score and non-PSD score were analyzed by independent sample t test to evaluate the discriminant validity of the scale.The internal consistency of the revised scale was evaluated by calculating the Cronbach’α coefficient.The Pearson coefficient r of each item score and the total score of the scale was calculated as the structural validity of the revised scale.The correlation validity of the scale was evaluated by correlating the revised scale and the HAMD depression score of the induction and validation groups.Result: There were no statistically significant differences in gender,age,education,and risk factors for common cerebrovascular disease such as hypertension and diabetes mellitus in the PSD group and the non-PSD group.Through the analysis of the original scale,the results show that the relationship of the left side of thelesion,frontal cortex and subcortical,thalamus with PSD is strong,given them the assignment of 2 points,the other item is still 1 point.According the arrangement combination principle obtained seven new scales.The optimal combination scale was selected by comparing the area under the ROC curve(AUC),Cronbach’s α coefficient and the discriminant validity of the seven scales.The results showed that the AUC value of the scale with the left side of the lesion,frontal cortex and subcortical assigned of 2 points was 0.752(95% CI),which was significantly higher than the AUC value of the original scale of 0.683.Selected this scale as the revised scale(left side of the lesion 2 points,frontal cortex and cortical 2 points,the edge of the structure,thalamus,temporal cortex and cortex,caudate nucleus and lentiform nucleus are 1 points),the total scale score is 8 points,scored between 0 to 6 points.By calculating the maximum Youden index(sensitivity + specificity-1),the optimal diagnostic value of the scale was 2 points,with the sensitivity of the PSD was about 75%,the specificity was about 65%.0 points in patients with PSD patients accounted for 4.28%,1 point in patients with PSD patients accounted for 21.26%,2 points PSD patients accounted for 32.65%,3 points PSD patients accounted for 57.14%,4 points or more PSD patients accounted for 93.40% ~ 100%,on basis of the best diagnostic value of the score we carried out the risk stratification of the revised scale,0 ~ 1 points is divided into low-risk group,2 to 3 points into the middle-risk group,4 points and more is divided into high-risk group.A total of 220 patients were enrolled in the revised group,76 patients in the PSD group and 144 patients in the non-PSD group.The AUC(0.758)of the revised scale was significantly higher than that of the AUC(0.681)of the original scale,demonstrating that the accuracy of the revised version of the PSD was significantly higher than that of the original scale.In the validation group,the positive rate of PSD was 78.95%,the negative rate was 72.90%,the incidence of PSD was 11.76% ~ 17.78% in 0 ~ 1points,the rate of PSD was 40.47 % ~ 64.29% in 2~3points,4 ~ 6 points in patients with PSD incidence rate of 92.31% ~ 100%,further confirmed that the scale identifying the PSD has a high accuracy,and the risk stratification is reasonable and accurate.Conclusion:(1)Revised the clinical magnetic resonance warning scale,and carried out the re-assignment of each items of the scale.The total score of the scale is 8 points,result between 0 to 6.(2)The scores of the scale were stratified,0 ~ 1 was divided into low risk group,2 ~ 3 divided into middle risk group,≥ 4 divided into high risk group.(3)When selected HAMD depression scale as the diagnostic criteria,the revised scale to identify the best diagnostic value of PSD is 2 points,and the true positive rate of identifying PSD is about 75%,the true negative rate was about 65%.(4)Revised PSD Magnetic Resonance Rating Scale still has a good internal consistency,which has a good discriminant validity for PSD patients.The score of the scale is linearly related to the HAMD depression score.(5)This scale can be one of the tool screening PSD,because the evaluation of it is simple and fast,the professional requirements of the evaluation staff is low,as well as applies to patients with language barriers.