2017-18 HSC Section 4 Green Book

Research Original Investigation

Body Dysmorphic Disorder in Facial Plastic Surgery Clinics

Figure 2. Pretest and Posttest Probabilities for Physician Diagnosis of Body Dysmorphic Disorder

Positive posttest vs pretest probability A

Negative posttest vs pretest probability B

1.0

1.0

0.8

0.8

0.6

0.6

0.4

0.4

Posttest Probability

Posttest Probability

0.2

0.2

0

0

0

0.2

0.4

0.6

0.8

1.0

0

0.2

0.4

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Pretest Probability

Pretest Probability

Shaded areas within bounds denote 95% CIs.

Table 3. Summary of Simple Logistic Regression Analysis for Baseline Factors Associated With Screening Positive on the Body Dysmorphic Disorder Questionnaire Independent Variable β Coefficient (SE) Z Ratio Odds Ratio (95% CI)

P Value

Sex

Female

0.59 (0.327)

1.8

1.8 (0.95-3.43)

.07

Male

[Reference]

Age

−0.017 (0.009)

−2.03

0.98 (0.96-0.99)

.04

Consultation type Cosmetic Reconstructive

0.741 (0.287)

2.59

2.10 (1.20-3.68)

.01

[Reference]

Abbreviations: BOE, blepharoplasty outcomes evaluation; FOE, facelift outcomes evaluation; ROE, rhinoplasty outcomes evaluation; SE, standard error; SROE, skin rejuvenation outcomes evaluation.

FACE-Q

−0.073 (0.010) −0.054 (0.017) −0.065 (0.018) −0.113 (0.026) −0.082 (0.027)

−0.073 0.93 (0.91-0.95)

<.001

ROE BOE FOE

−3.04 −3.55 −4.30 −2.98

0.95 (0.92-0.98) 0.94 (0.90-0.97) 0.89 (0.85-0.94) 0.92 (0.87-0.97)

.002

<.001 <.001

SROE

.003

negative predictive value was 89.4% (95% CI, 85.9%-92.3%). The positive and negative likelihood ratios for surgeon diag- nosis were 1.19 (95% CI, 0.3-5.1) and 1.0 (95% CI, 0.9-1.1), re- spectively, and both 95%CIs contain one suggesting that little additional information is gained for discriminating BDD sta- tus of a patient based on clinical diagnosis of a surgeon. The ROC area was 0.50 (95% CI, 0.47-0.54). Plots of pretest and posttest probability for surgeondiagnosis are shown in Figure2 . Despitepoor ability topredict BDDstatus, surgeons hadamean (SD) certainty of 89.0% (15.3%) (median, 90%) of the accu- racy of their ability to screen for BDD. The multiple imputa- tion results are all within the presented95%CIs presented sug- gesting these results are robust to missing data. Factors Associated With BDDQ Status Logistic regression analysis revealed that age and category of consultation (cosmetic consultation vs reconstructive or func- tional) were associated with BDDQ status ( Table 3 ). Specifi- cally, patients who were younger (OR, 0.98; 95% CI, 0.96- 0.99; P = .04) orwhopresented for primarily cosmetic concerns (OR, 2.10; 95%CI, 1.20-3.68; P = .01) weremore likely to screen

of patients screening positive across the 3 study sites (χ 2 [2, N = 597] = 1.11; P = .57). Patients presenting primarily for cos- metic purposes (37 of 283 patients [13.1%]) were more likely than those presenting for reconstructive reasons (21 of 314 pa- tients [6.7%]) to screen positive on the BDDQ odds ratio [OR], 2.10; 95% CI, 1.20-3.68; P = .01). Surgeon Diagnostic Accuracy The diagnostic accuracy of surgeons in performing clinical screening for BDD was compared with that of the validated BDDQ screening instrument. A total of 402 patients com- pleted the baseline screening surveys andwere also screened by a surgeon. Independent of BDDQ status, a total of 16 pa- tients (4.0%)were suspectedby surgeons as havingBDD.While 43 out of the402patients (10.7%; 95%CI, 7.8%-14.1%) screened positive on the BDDQ instrument, only 2 of these patients (4.7%) were correctly identified by surgeons as having BDD. The sensitivity of surgeon diagnosis of BDD when compared with the BDDQ was 4.7% (95% CI, 0.6%-15.8%) with a speci- ficity of 96.1% (95% CI, 93.5%-97.9%). The positive predic- tive value was found to be 12.5% (95% CI, 1.6%-38.3%) and

JAMA Facial Plastic Surgery Published online December 8, 2016 (Reprinted)

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