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Assessment concordance and predictive validity of self-report and biological assay of cocaine use in treatment trials.

ABSTRACT: Cocaine use during randomized clinical trials (RCTs) is typically assessed by participant self-report or biological assay (eg, urinalysis). There have been few direct comparisons of these assessment methods to investigate their concordance and their predictive validity for cocaine use and psychosocial outcomes following treatment completion.In a combined sample of 380 participants from 5 cocaine RCTs, the concordance between cocaine use assessment methods was examined. Sequential multiple linear and logistic regression models evaluated the predictive validity of two assessment methods for cocaine use and psychosocial outcomes assessed at 1, 3, 6, and 12 months after treatment.Concordance for self-report and urinalysis indicators of cocaine use was high within-treatment (k?=?0.72) and moderate during follow-up (k?=?0.51). Rates of concordance were higher in studies using test cups with immediate urinalysis results. Regression analyses indicated that self-report data within-treatment predicted self-reported cocaine use at all post-treatment points (? 0.22-0.30, p?

SUBMITTER: Decker SE

PROVIDER: S-EPMC4139466 | biostudies-literature | 2014 Sep-Oct

REPOSITORIES: biostudies-literature

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Assessment concordance and predictive validity of self-report and biological assay of cocaine use in treatment trials.

Decker Suzanne E SE Frankforter Tami T Babuscio Theresa T Nich Charla C Ball Samuel A SA Carroll Kathleen M KM

The American journal on addictions 20140315 5

<h4>Background and objectives</h4>Cocaine use during randomized clinical trials (RCTs) is typically assessed by participant self-report or biological assay (eg, urinalysis). There have been few direct comparisons of these assessment methods to investigate their concordance and their predictive validity for cocaine use and psychosocial outcomes following treatment completion.<h4>Method</h4>In a combined sample of 380 participants from 5 cocaine RCTs, the concordance between cocaine use assessment ...[more]

PMID: 24628970

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Project description:ImportanceThe ability of present-day etiologic stroke classification systems to generate subtypes with discrete stroke characteristics is not known.ObjectiveTo test the hypothesis that etiologic stroke subtyping identifies different disease processes that can be recognized through their different clinical courses.Design, setting, and participantsWe performed a head-to-head evaluation of the ability of the Causative Classification of Stroke (CCS), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and ASCO (A for atherosclerosis, S for small-vessel disease, C for cardiac source, and O for other cause) classification systems to generate etiologic subtypes with different clinical, imaging, and prognostic characteristics in 1816 patients with ischemic stroke. This study included 2 cohorts recruited at separate periods; the first cohort was recruited between April 2003 and June 2006 and the second between June 2009 and December 2011. Data analysis was performed between June 2014 and May 2016.Main outcomes and measuresSeparate teams of stroke-trained neurologists performed CCS, TOAST, and ASCO classifications based on information available at the time of hospital discharge. We assessed the association between etiologic subtypes and stroke characteristics by computing receiver operating characteristic curves for binary variables (90-day stroke recurrence and 90-day mortality) and by calculating the ratio of between-category to within-category variability from the analysis of variance for continuous variables (admission National Institutes of Health Stroke Scale score and acute infarct volume).ResultsAmong the 1816 patients included, the median age was 70 years (interquartile range, 58-80 years) (830 women [46%]). The classification systems differed in their ability to assign stroke etiologies into known subtypes; the size of the undetermined category was 33% by CCS, 53% by TOAST, and 42% by ASCO (P < .001 for all binary comparisons). All systems provided significant discrimination for the validation variables tested. For the primary validation variable (90-day recurrence), the area under the receiver operating characteristic curve was 0.71 (95% CI, 0.66-0.75) for CCS, 0.61 (95% CI, 0.56-0.67) for TOAST, and 0.66 (95% CI, 0.60-0.71) for ASCO (P = .01 for CCS vs ASCO; P < .001 for CCS vs TOAST; P = .13 for ASCO vs TOAST). The classification systems exhibited similar discrimination for 90-day mortality. For admission National Institutes of Health Stroke Scale score and acute infarct volume, CCS generated more distinct subtypes with higher between-category to within-category variability than TOAST and ASCO.Conclusions and relevanceOur findings suggest that the major etiologic stroke subtypes are distinct categories with different stroke characteristics irrespective of the classification system used to identify them. We further show that CCS generates discrete etiologic categories with more diverse clinical, imaging, and prognostic characteristics than either TOAST or ASCO.

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Assessment concordance and predictive validity of self-report and biological assay of cocaine use in treatment trials.

Publications

Assessment concordance and predictive validity of self-report and biological assay of cocaine use in treatment trials.

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