scholarly journals The diagnostic performance of chest computed tomography in the detection of rib fractures in children investigated for suspected physical abuse: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Nasser M Alzahrani ◽  
Annmarie Jeanes ◽  
Michael Paddock ◽  
Farag Shuweihdi ◽  
Amaka C. Offiah
Keyword(s):  
Physical Abuse ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
High Specificity ◽  
Chest Ct ◽  
Rib Fractures ◽  
Chest Radiographs ◽  
Skeletal Survey ◽  
Fractures In Children ◽  
Low Sensitivity

Abstract Objectives To assess the diagnostic performance of chest CT in the detection of rib fractures in children investigated for suspected physical abuse (SPA). Methods Medline, Web of Science and Cochrane databases were searched from January 1980 to April 2020. The QUADAS-2 tool was used to assess the quality of the eligible English-only studies following which a formal narrative synthesis was constructed. Studies reporting true-positive, false-positive, true-negative, and false-negative results were included in the meta-analysis. Overall sensitivity and specificity of chest CT for rib fracture detection were calculated, irrespective of fracture location, and were pooled using a univariate random-effects meta-analysis. The diagnostic accuracy of specific locations along the rib arc (anterior, lateral or posterior) was assessed separately. Results Of 242 identified studies, 4 met the inclusion criteria. Of these, 2 were included in the meta-analysis. Chest CT identified 142 rib fractures compared to 79 detected by initial skeletal survey chest radiographs in live children with SPA. Post-mortem CT (PMCT) has low sensitivity (34%) but high specificity (99%) in the detection of rib fractures when compared to the autopsy reference standard. PMCT has low sensitivity (45%, 21% and 42%) but high specificity (99%, 97% and 99%) at anterior, lateral and posterior rib locations, respectively. Conclusions Chest CT detects more rib fractures than initial skeletal survey chest radiographs in live children with SPA. PMCT has low sensitivity but high specificity for detecting rib fractures in children investigated for SPA. Key Points • PMCT has low sensitivity (34%) but high specificity (99%) in the detection of rib fractures; extrapolation to CT in live children is difficult. • No studies have compared chest CT with the current accepted practice of initial and follow-up skeletal survey chest radiographs in the detection of rib fractures in live children investigated for SPA.

scholarly journals Early chest computed tomography to diagnose COVID-19 from suspected patients: A multicenter retrospective study

2020 ◽  
Author(s):  
Congliang Miao ◽  
Mengdi Jin ◽  
Li Miao ◽  
Xinying Yang ◽  
Peng Huang ◽  
...  
Keyword(s):  
Ground Glass Opacity ◽  
High Specificity ◽  
Diagnostic Value ◽  
Chest Ct ◽  
Imaging Features ◽  
Rt Pcr ◽  
Polymerase Chain ◽  
Low Sensitivity ◽  
Chest Ct Scan ◽  
Ct Features

AbstractObjectiveThe purpose of this study is to distinguish the imaging features of COVID-19 with other chest infectious diseases and evaluate diagnostic value of chest CT for suspected patients.MethodsAdult suspected patients aged>18 years within 14 days who underwent chest CT scan and reverse-transcription polymerase-chain-reaction (RT-PCR) tests were enrolled. The enrolled patients were confirmed and grouped according to results of RT-PCR tests. The data of basic demographics, single chest CT features, and combined chest CT features were analyzed for confirmed and non-confirmed groups.ResultsA total of 130 patients were enrolled with 54 cases positive and 76 cases negative. The typical CT imaging features of positive group were ground glass opacity (GGO), crazy-paving pattern and air bronchogram. The lesions were mostly distributed bilaterally, close to the lower lungs or the pleura. When features combined, GGO with bilateral pulmonary distribution and GGO with pleural distribution were more common, of which were 31 cases (57.4%) and 30 cases (55.6%) respectively. The combinations were almost presented statistically significant (P<0.05) except for the combination of GGO with consolidation. Most combinations presented relatively low sensitivity but extremely high specificity. The average specificity of these combinations is around 90%.ConclusionsThe combinations of GGO could be useful in the identification and differential diagnosis of COVID-19, which alerts clinicians to isolate patients for treatment promptly and repeat RT-PCR tests until incubation ends.

Add-on bone scintigraphy after negative radiological skeletal survey for the diagnosis of skeletal injury in children suspected of physical abuse: a systematic review and meta-analysis

2020 ◽  
pp. archdischild-2020-319065
Author(s):  
Flora Blangis ◽  
Melissa Taylor ◽  
Catherine Adamsbaum ◽  
Anne Devillers ◽  
Christèle Gras-Le Guen ◽  
...  
Keyword(s):  
Physical Abuse ◽  
Bone Scintigraphy ◽  
Detection Rate ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Skeletal Survey ◽  
Absolute Increase ◽  
Skeletal Injury ◽  
Number Of Children ◽  
Meta Analyses

Objective(s)To systematically assess the extent to which bone scintigraphy (BS) could improve the detection rate of skeletal injury in children suspected of physical abuse with an initial negative radiological skeletal survey (RSS).Study designWe searched MEDLINE and Web of Science for series of ≥20 children suspected of physical abuse who underwent RSS and add-on BS. We assessed the risk of bias and the heterogeneity and performed random-effects meta-analyses.ResultsAfter screening 1140 unique search results, we reviewed 51 full-text articles, and included 7 studies (783 children, mostly ≤3 years old). All studies were of either high or unclear risk of bias. Substantial heterogeneity was observed in meta-analyses. The summary detection rate of skeletal injury with RSS alone was 52% (95% CI 37 to 68). The summary absolute increase in detection rate with add-on BS was 10 percentage points (95% CI 6 to 15); the summary relative detection rate was 1.19 (95% CI 1.13 to 1.25); the summary number of children with a negative RSS who needed to undergo a BS to detect one additional child with skeletal injury (number needed to test) was 3 (95% CI 2 to 7).ConclusionsFrom the available evidence, add-on BS in young children suspected of physical abuse with a negative RSS might allow for a clinically significant improvement of the detection rate of children with skeletal injury, for a limited number of BS procedures required. The quality of the reviewed evidence was low, pointing to the need for high-quality studies in this field.

scholarly journals Urinary EN-2 to predict prostate cancer: Systematic review and meta-analysis

2017 ◽  
Vol 63 (7) ◽  
pp. 656-661 ◽  
Author(s):  
Maria Inês da Rosa ◽  
Eduardo Ronconi Dondossola ◽  
Maria Cecilia Manenti Alexandre ◽  
Kristian Madeira ◽  
Florentino de Araújo Cardoso ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Meta Analysis ◽  
Specific Antigen ◽  
High Specificity ◽  
Cochrane Library ◽  
Language Restriction ◽  
Comprehensive Search ◽  
Control Disease ◽  
Low Sensitivity ◽  
Abstract Screening

Summary Introduction: Prostate cancer is the second type of cancer diagnosed and the fifth cause of death in men worldwide. Early diagnosis helps to control disease progression. Currently, prostate specific antigen is the standard biomarker, as it has a broad scope of identification and, thus, new and more specific biomarkers must be studied. Objective: To evaluate the accuracy of engrailed-2 protein (EN2) in urine as a prostate cancer biomarker. Method: A comprehensive search was conducted in the period from January 2005 to July 2016 using the following electronic databases: Medline (PubMed), Embase, Cochrane Library and Lilacs. The keywords used in the databases were: "engrailed-2," "EN2," "prostatic neoplasms." The search was limited to humans and there was no language restriction. Critical appraisal of the included studies was performed according to Quadas-2. Statistical analysis was performed using Meta-DiSc® and RevMan 5.3 softwares. Results: A total of 248 studies were identified. After title and abstract screening, 231 studies were removed. A total of 17 studies were read in full and two studies were included in the meta-analysis. The pooled sensitivity was 66% (95CI 0.56-0.75) and specificity was 89% (95CI 0.86-0.92). The DOR was 15.08 (95CI 8.43-26.97). Conclusion: The EN2 test showed high specificity (89%) and low sensitivity (66%).

scholarly journals Diagnostic Performance of Xpert MTB/RIF in Tuberculous Pleural Effusion: Systematic Review and Meta-analysis

2016 ◽  
Vol 54 (4) ◽  
pp. 1133-1136 ◽  
Author(s):  
Inderpaul Singh Sehgal ◽  
Sahajal Dhooria ◽  
Ashutosh Nath Aggarwal ◽  
Digambar Behera ◽  
Ritesh Agarwal
Keyword(s):  
Systematic Review ◽  
Pleural Effusion ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Reference Standard ◽  
Tuberculous Pleural Effusion ◽  
Low Sensitivity ◽  
Composite Reference Standard

A systematic review investigating the role of Xpert MTB/RIF in the diagnosis of tuberculous pleural effusion (TPE) was conducted. The pooled sensitivities and specificities of Xpert MTB/RIF were 51.4% and 98.6%, respectively, with culture used as a reference standard and 22.7% and 99.8%, respectively, with a composite reference standard (CRS) used as the benchmark. Xpert MTB/RIF has low sensitivity but excellent specificity in the diagnosis of TPE.

scholarly journals Chest radiographs versus CT for the detection of rib fractures in children (DRIFT): a diagnostic accuracy observational study

2018 ◽  
Vol 2 (11) ◽  
pp. 802-811 ◽  
Author(s):  
Susan C Shelmerdine ◽  
Dean Langan ◽  
John C Hutchinson ◽  
Melissa Hickson ◽  
Kerry Pawley ◽  
...  
Keyword(s):  
Observational Study ◽  
Diagnostic Accuracy ◽  
Rib Fractures ◽  
Chest Radiographs ◽  
Fractures In Children

scholarly journals The performance of Chest CT and Its Imaging Features for Diagnosing Coronavirus Disease 2019: a Meta-analysis

2020 ◽  
Author(s):  
Shuo Zhang ◽  
Zhewei Zhao ◽  
Chen Li ◽  
Wen Zhang ◽  
Shuyang Zhang
Keyword(s):  
Likelihood Ratio ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Negative Likelihood Ratio ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Chest Ct ◽  
Cochrane Library ◽  
Imaging Features ◽  
Rt Pcr

Abstract Early diagnosis and isolation of cases are particularly crucial for coronavirus disease 2019 (COVID-19) in global pandemic. The aim of this study is to determine the diagnostic performance of chest computed tomography (CT) and imaging features for diagnosing COVID-19. Diagnostic accuracy studies of CT and RT-PCR in patients with clinically suspected COVID-19, which were published up to April 25th, 2020 from MEDLINE, EMBASE, and the Cochrane Library. Twelve studies (n=2,204) were included. The pooled sensitivity, specificity, likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of chest CT for detecting COVID-19 were 94.5% (95% confidence interval (CI) 89.5 to 97.2%) and 41.8% (95% CI 24.2 to 61.6%), 1.6 (95% CI: 1.6-2.3), 0.13 (95% CI: 0.06-0.31), and 12.4 (95% CI: 4.0-38.5), respectively. Initial RT-PCR revealed a better diagnostic performance. Peripheral lesions, bilateral involvement, multiple lesions, and ground-glass opacities (GGO), revealed to be with better diagnostic value than other CT manifestations. Using chest CT for COVID-19 diagnosis has a high sensitivity and a relatively low specificity. Bilateral multiple peripheral lesions and GGO revealed to be with better diagnostic value. For areas with high prevalence, chest CT could be a good screening test to preliminary screen patients with COVID-19 quickly.

scholarly journals Diagnostic accuracy of 18F flucholine PET/CT for preoperative lymph node staging in newly diagnosed prostate cancer patients; a systematic review and meta-analysis

2019 ◽  
Vol 92 (1101) ◽  
pp. 20190193 ◽  
Author(s):  
Seong-Jang Kim ◽  
Sang Woo Lee
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Meta Analysis ◽  
High Specificity ◽  
Lymph Node Staging ◽  
Newly Diagnosed ◽  
Pet Ct ◽  
Low Sensitivity

Objectives: The purpose of the current study was to investiagte the diagnostic accuracy of 18F flucholine (FCH) positron emission tomography/CT (PET/CT) for pre-operative lymph node (LN) staging in newly diagnosed prostate cancer (PCa) patients using meta-analysis. Methods: PubMed and Embase from the earliest available date of indexing through December 31, 2018, were searched for studies evaluating the diagnostic performance of 18F FCH PET/CT for preoperative LN staging in newly diagnosed PCa. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR + and LR-), and constructed summary receiver operating characteristic curves. Results: Across seven studies (627 patients), the pooled sensitivity was 0.57 [95% confidence interval (CI) (0.42–0.70)] and a pooled specificity of 0.94 [95% CI (0.89–0.97)]. Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 10.2 (95% CI; 5.0–21.0) and negative likelihood ratio (LR-) of 0.46 (95% CI; 0.33–0.64). The pooled diagnostic odds ratio was 22 (95% CI; 9–54). Conclusions: 18F FCH PET/CT shows a low sensitivity and high specificity for the detection of metastatic LNs in patients with newly diagnosed PCa. Also, 18F FCH PET/CT is only useful for confirmation of LN metastasis (when positive) in PCa patients. Advances in knowledge: 18F FCH PET/CT demonstrates low sensitivity but high specificity for diagnosis of metastatic LNs in patients with newly diagnosed PCa. Also, 18F FCH PET/CT is only useful for confirmation of LN metastasis (when positive) in PCa patients.

scholarly journals Diagnostic power of chest CT for COVID-19: to screen or not to screen

2020 ◽  
Author(s):  
K. De Smet ◽  
D. De Smet ◽  
I. Demedts ◽  
B. Bouckaert ◽  
T. Ryckaert ◽  
...  
Keyword(s):  
High Sensitivity ◽  
High Specificity ◽  
Diagnostic Value ◽  
Chest Ct ◽  
Respiratory Pathogens ◽  
Likelihood Ratios ◽  
Asymptomatic Patients ◽  
Diagnostic Power ◽  
Low Sensitivity ◽  
A Prospective Study

Structured abstractBackgroundchest CT is increasingly used for COVID-19 screening in healthcare systems with limited SARS-CoV-2 PCR capacity. Its diagnostic value was supported by studies with methodological concerns and its use is controversial. Here we investigated its potential to diagnose COVID-19 in symptomatic patients and to screen asymptomatic patients in a prospective study with minimal selection bias.MethodsFrom March 19, 2020 to April 20, 2020 we performed parallel SARS-CoV-2 PCR and CT with categorization of COVID-19 suspicion by CO-RADS, in 859 patients with COVID-19 symptoms and 1138 controls admitted to the hospital for COVID-19 unrelated medical urgencies. CT-CORADS was categorized on a 5-point scale from 1 (very low suspicion) to 5 (very high suspicion). AUC under ROC curve were calculated in symptomatic versus asymptomatic patients to predict positive SARS-CoV-2 positive PCR and likelihood ratios for each CO-RADS score were used for rational selection of diagnostic thresholds.FindingsCT-CORADS had significant (P<0.0001) diagnostic power in both symptomatic (AUC=0.891) and asymptomatic (AUC=0.700) patients hospitalized during SARS-CoV-2 peak prevalence. In symptomatic patients (41.7% PCR+), CO-RADS ≥ 3 detected positive PCR with high sensitivity (89.1%) and 72.5% specificity. In asymptomatic patients (5.3% PCR+), a CO-RADS score ≥ 3 detected SARS-CoV-2 infection with low sensitivity (45.0%) but high specificity (88.8%).InterpretationCT-CORADS has meaningful diagnostic power in symptomatic patients, supporting its application for time-sensitive triage. Sensitivity in asymptomatic patients is insufficient to justify its use as screening approach. Incidental detection of CO-RADS ≥ 3 in asymptomatic patients should trigger reflex testing for respiratory pathogens.

Hit and False-Alarm Rates of Selected ABR Indices in Differentiating Cochlear Disorders From Acoustic Tumors

1996 ◽  
Vol 5 (1) ◽  
pp. 90-96 ◽  
Author(s):  
Frank E. Musiek ◽  
Cynthia A. McCormick ◽  
Raymond M. Hurley
Keyword(s):  
False Alarm ◽  
Amplitude Ratio ◽  
High Specificity ◽  
Auditory Brainstem ◽  
Latency Difference ◽  
Cochlear Pathology ◽  
Brainstem Response ◽  
Absolute Latency ◽  
Two Indices ◽  
Low Sensitivity

We performed a retrospective study of 26 patients with acoustic tumors and 26 patients with otologically diagnosed cochlear pathology to determine the sensitivity (hit rate), specificity (false-alarm rate), and efficiency of six auditory brainstem response indices. In addition, a utility value was determined for each of these six indices. The I–V interwave interval, the interaural latency difference, and the absolute latency of wave V provided the highest hit rates, the best A’ values and good utility. The V/I amplitude ratio index provided high specificity but low sensitivity scores. In regard to sensitivity and specificity, using the combination of two indices provided little overall improvement over the best one-index measures.

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