The time is now for new, lower diabetes diagnostic thresholds

Abstract Background Cornell assessment of pediatric delirium (CAPD) showed advantage in diagnosis of pediatric delirium in Chinese critically ill patients. But its performance in surgical patients is still unclear. The present study was designed to validate the diagnostic performance of CAPD in surgical pediatric patients. Methods This is a prospective validation study. Pediatric patients who underwent selective surgery and general anesthesia were enrolled. Primary outcome was the incidence of delirium within postoperative three days. CAPD Chinese version was used to evaluate if the patient had delirium one time per day. At the meantime, a psychiatrist employed Diagnostic and Statistical Manual of Mental Disorders fifth edition to diagnose delirium, which was the “gold standard”, and the result was considered as reference standard. Sensitivity, specificity and area under receiver operating characteristic (ROC) curve were calculated to investigate the performance of CAPD. Results A total of 170 patients were enrolled. Median age was 4 years old. As diagnosed by psychiatrist, 23 (13.5 %) patients experienced at least one episode of delirium during the follow-up period. When diagnostic threshold was set at 9, CAPD showed the optimal sensitivity (87.0 %, 95 %CI 65.3 %-96.6 %) and specificity (98.0 %, 95 %CI 93.7 %-99.5 %) in comparison with other diagnostic thresholds. ROC analysis showed that CAPD was a good delirium assessment instrument with area under curve of 0.911 (95 % CI 0.812 to 1.000, P < 0.001). Agreement between CAPD and reference standard was 0.849 (Kappa coefficient, P < 0.001). Conclusions This study found that Cornell assessment of pediatric delirium could be used as an effective instrument in diagnosis of delirium in pediatric surgical patients. Trial registration www.chictr.org.cn Identifier: ChiCTR-DDD-17,012,231, August 3, 2017.

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ESR and CRP Diagnostic Thresholds for Prosthetic Joint Infection in Hip Hemiarthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0040-1719115 ◽

2020 ◽

Vol 4 (04) ◽

pp. 187-192

Author(s):

Jared A. Warren ◽

Oliver Scotting ◽

Hiba K. Anis ◽

James Bircher ◽

Alison K. Klika ◽

...

Keyword(s):

Prosthetic Joint Infection ◽

Joint Infection ◽

Area Under The Curve ◽

Roc Curves ◽

Musculoskeletal Infection ◽

Hip Hemiarthroplasty ◽

Diagnostic Thresholds ◽

Diagnostic Threshold ◽

Prosthetic Joint ◽

The Mean

AbstractDiagnostic thresholds used to standardize the definition for prosthetic joint infection (PJI) have largely focused on total joint arthroplasty (TJA). Established PJI thresholds exist for serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in TJA; however, they do not exist for revision hip hemiarthroplasty (rHHA). The purpose of this study was to establish thresholds for (1) ESR and (2) CRP to diagnose PJI in rHHA. Data were collected on a prospective cohort of 69 rHHA patients undergoing orthopaedic surgery between 1/2017 and 2/2019 in a single health care system. Procedures were categorized as septic or aseptic revisions using Musculoskeletal Infection Society (MSIS) criteria (2013). There were 44 ESRs (n = 28 aseptic, n = 16 septic) and 46 CRPs (n = 29 aseptic, n = 17 septic) available for analysis. Two tailed t-tests were performed to compare the mean ESR and CRP in aseptic and septic cases. Receiver operator characteristic (ROC) curves were generated to obtain diagnostic cutoff thresholds using the Youden's Index (J) for ESR and CRP. The mean ESR was 50.3 ± 30.6 mm/h versus 15.4 ± 17.7 mm/h (p < 0.001), while the mean CRP was 29.9 ± 24.8 mg/L versus 4.1 ± 8.2 mg/L (p < 0.001) for septic and aseptic revisions, respectively. The diagnostic threshold for PJI determined by the ROC curve was 44 mm/h for ESR (sensitivity = 56.3%; specificity = 100.0%; J = 0.563; area under the curve (AUC) = 0.845), while it was 12.5 mg/L for CRP (sensitivity = 70.6%; specificity = 96.6%; J = 0.672; AUC = 0.896). For patients with HHA, an ESR of 44 mm/h was and a CRP of 12.5 mg/L was highly specific for PJI. The thresholds are similar to the MSIS thresholds currently published. Larger prospective trials are needed to establish more robust and conclusive diagnostic criteria for PJI in HHA, including investigations not only of ESR and CRP but synovial white blood cell count and synovial polymorphonuclear leukocytes % as well.

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AGE AND THE EFFECTIVENESS OF RISK STRATIFICATION AND DIAGNOSTIC THRESHOLDS FOR MYOCARDIAL INFARCTION WITH HIGH-SENSITIVITY CARDIAC TROPONIN

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)33628-8 ◽

2017 ◽

Vol 69 (11) ◽

pp. 239

Author(s):

Atul Anand ◽

Andrew Chapman ◽

Anoop Shah ◽

Philip Adamson ◽

Amy Ferry ◽

...

Keyword(s):

Myocardial Infarction ◽

Risk Stratification ◽

Cardiac Troponin ◽

High Sensitivity ◽

Diagnostic Thresholds

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Bravo Catheter-Free pH Monitoring: Normal Values, Concordance, Optimal Diagnostic Thresholds, and Accuracy

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2008.08.020 ◽

2009 ◽

Vol 7 (1) ◽

pp. 60-67 ◽

Cited By ~ 73

Author(s):

Shahin Ayazi ◽

John C. Lipham ◽

Giuseppe Portale ◽

Christian G. Peyre ◽

Christopher G. Streets ◽

...

Keyword(s):

Normal Values ◽

Ph Monitoring ◽

Diagnostic Thresholds

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Rethinking low risk micropapillary thyroid cancer: an evidence review for recalibrating diagnostic thresholds and/or alternative labels

Thyroid ◽

10.1089/thy.2021.0274 ◽

2021 ◽

Author(s):

Tara Ma ◽

Caitlin R Semsarian ◽

Alexandra Barratt ◽

Lisa Parker ◽

M. Priyanthi Kumarasinghe ◽

...

Keyword(s):

Thyroid Cancer ◽

Low Risk ◽

Diagnostic Thresholds ◽

Evidence Review

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Effect of different diagnostic thresholds on dental caries calibration - a 12 month evaluation

Community Dentistry And Oral Epidemiology ◽

10.1111/j.1600-0528.2006.00278.x ◽

2006 ◽

Vol 34 (3) ◽

pp. 213-219 ◽

Cited By ~ 31

Author(s):

Andrea Videira Assaf ◽

Marcelo de Castro Meneghim ◽

Luciane Zanin ◽

Cristiana Tengan ◽

Antonio Carlos Pereira

Keyword(s):

Dental Caries ◽

Diagnostic Thresholds

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Abstract P361: Prevalence & Predictors of Orthostatic Hypotension at a Tertiary Care Hypertension Clinic With New Diagnostic Thresholds

Hypertension ◽

10.1161/hyp.70.suppl_1.p361 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Swapnil Hiremath ◽

Mohammad A Faraz ◽

Brendan McCormick ◽

Marcel Ruzicka

Keyword(s):

Orthostatic Hypotension ◽

Diagnostic Yield ◽

Tertiary Care ◽

Renal Hypertension ◽

Routine Practice ◽

Sit To Stand ◽

Hypertension Clinic ◽

Diagnostic Thresholds ◽

Diagnostic Threshold ◽

The Difference

Background: Orthostatic hypotension (OH), defined as a decrease of blood pressure (BP) of 20/10 mm Hg (systolic/diastolic) on change in posture from supine to standing is seldom assessed in routine practice because of logistical constraints. A recent study reported a sit-to-stand decrease of 15/7 mm Hg as also having good diagnostic yield. We measured the prevalence & risk factors associated with OH with the new threshold of sit-to- stand of either ≥ 15 mm Hg in systolic (SBP) or ≥ 7 mm Hg in diastolic BP (DBP). Methods: We reviewed medical charts of patients being followed at Renal Hypertension Center, a referral centre for difficult to control hypertension. Sitting BP is measured after 5 minutes of resting, as an average of 5 measurements with an automated device. Standing BP is measured three times at one minute intervals and averaged. OH was determined on the basis of the difference in either average SBP or DBP. Demographic characteristics, comorbidities, medication details, laboratory values and BP measurements were extracted. Results: Data from 219 patients was extracted (see table). The overall difference in SBP (sitting - standing)was 0.94 and DBP was 2.1 mm Hg. 190 patients (87%) did not have OH, whereas 29 (13%) had OH using either SBP or DBP thresholds. The difference in SBP and DBP was 17 mm and 6 mm Hg in those with OH, versus 1.6 and 3 mm Hg amongst those without OH respectively. Higher SBP was significantly associated with OH; age, gender, diabetes, number and hypertension drug class were not. Conclusion: Amongst referred patients to a specialist hypertension clinic, the prevalence of OH using a threshold of 15/7 mm Hg was 13%. The new diagnostic threshold allows for easy assessment of OH.

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Genetics of severe insulin resistance

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.1355 ◽

2011 ◽

pp. 1759-1764

Author(s):

Robert K. Semple ◽

David B. Savage ◽

Stephen O’Rahilly

Keyword(s):

Insulin Resistance ◽

Insulin Signalling ◽

Single Gene ◽

Clinical History ◽

Insulin Requirement ◽

Exogenous Insulin ◽

Oral Glucose Tolerance Testing ◽

Severe Insulin Resistance ◽

Diagnostic Thresholds ◽

Normal Ranges

As the prevalence of obesity burgeons, so the prevalence of insulin resistance follows. A small minority of patients have severe insulin resistance without obesity. These patients, while not contributing significantly to the general prevalence of diabetes, often harbour pathogenic single gene defects affecting insulin signalling or adipose tissue function. Clinical history and examination may offer strong clues to the presence of severe insulin resistance, but laboratory confirmation should usually be sought. Biochemical diagnostic thresholds for severe insulin resistance are arbitrary, and should, ideally, be defined relative to BMI-adjusted population normal ranges (Fig. 13.3.5.1). However, one set of approximate diagnostic criteria is as follows: ◆ non-diabetic and BMI under 30 kg/m2—fasting insulin above 150 pmol/l OR peak insulin on oral glucose tolerance testing above 1500 pmol/l ◆ absolute insulin deficiency and BMI under 30 kg/m2—exogenous insulin requirement above 3 U/kg/day ◆ partial β‎ cell decompensation and/or BMI over 30 kg/m2—insulin levels are difficult to interpret in the context of obesity, while, in diabetes, glucotoxicity, impaired islet function, and a combination of endogenous and exogenous insulin in the circulation confuse the biochemical picture. In this setting, the clinical history and features such as acanthosis nigricans assume particular importance in making a diagnosis of likely monogenic severe insulin resistance, with subjective clinical judgement often required.

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