A validation study of a clinical prediction rule for screening asymptomatic chlamydia and gonorrhoea infections among heterosexuals in British Columbia
- 1The School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- 2British Columbia Center for Disease Control, Vancouver, British Columbia, Canada
- 3The Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
- Correspondence to Dr Titilola Falasinnu, The School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada BC V6T 1Z3;
- Received 23 December 2014
- Revised 25 March 2015
- Accepted 11 April 2015
- Published Online First 30 April 2015
Background One component of effective sexually transmitted infections (STIs) control is ensuring those at highest risk of STIs have access to clinical services because terminating transmission in this group will prevent most future cases. Here, we describe the results of a validation study of a clinical prediction rule for identifying individuals at increased risk for chlamydia and gonorrhoea infection derived in Vancouver, British Columbia (BC), against a population of asymptomatic patients attending sexual health clinics in other geographical settings in BC.
Methods We examined electronic records (2000–2012) from clinic visits at seven sexual health clinics in geographical locations outside Vancouver. The model's calibration and discrimination were examined by the area under the receiver operating characteristic curve (AUC) and the Hosmer–Lemeshow (H-L) statistic, respectively. We also examined the sensitivity and proportion of patients that would need to be screened at different cut-offs of the risk score.
Results The prevalence of infection was 5.3% (n=10 425) in the geographical validation population. The prediction rule showed good performance in this population (AUC, 0.69; H-L p=0.26). Possible risk scores ranged from −2 to 27. We identified a risk score cut-off point of ≥8 that detected cases with a sensitivity of 86% by screening 63% of the geographical validation population.
Conclusions The prediction rule showed good generalisability in STI clinics outside of Vancouver with improved discriminative performance compared with temporal validation. The prediction rule has the potential for augmenting triaging services in STI clinics and enhancing targeted testing in population-based screening programmes.