The development of a population-level clinical screening tool for self-harm repetition and suicide: the ReACT Self-Harm Rule

BackgroundSelf-harm is a common reason for Emergency Department (ED) attendance. We aimed to develop a clinical tool to help identify patients at higher risk of repeat self-harm, or suicide, within 6 months of an ED self-harm presentation.MethodThe tool, the ReACT Self-Harm Rule, was derived using multicentre data from a prospective cohort study. Binary recursive partitioning was applied to data from two centres, and data from a separate centre were used to test the tool. There were 29 571 self-harm presentations to five hospital EDs between January 2003 and June 2007, involving 18 680 adults aged ⩾16 years. We estimated sensitivity, specificity and positive and negative predictive values to measure the performance of the tool.ResultsA self-harm presentation was classified as higher risk if at least one of the following factors was present: recent self-harm (in the past year), living alone or homelessness, cutting as a method of harm and treatment for a current psychiatric disorder. The rule performed with 95% sensitivity [95% confidence interval (CI) 94–95] and 21% specificity (95% CI 21–22), and had a positive predictive value of 30% (95% CI 30–31) and a negative predictive value of 91% (95% CI 90–92) in the derivation centres; it identified 83/92 of all subsequent suicides.ConclusionsThe ReACT Self-Harm Rule might be used as a screening tool to inform the process of assessing self-harm presentations to ED. The four risk factors could also be used as an adjunct to in-depth psychosocial assessment to help guide risk formulation. The use of multicentre data helped to maximize the generalizability of the tool, but we need to further verify its external validity in other localities.

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Validation of a rapid antigen test as a screening tool for SARS-CoV-2 infection in asymptomatic populations. Sensitivity, specificity and predictive values

EClinicalMedicine ◽

10.1016/j.eclinm.2021.100954 ◽

2021 ◽

pp. 100954

Author(s):

Alejandro Fernandez-Montero ◽

Josepmaria Argemi ◽

José Antonio Rodríguez ◽

Arturo H. Ariño ◽

Laura Moreno-Galarraga

Keyword(s):

Screening Tool ◽

Antigen Test ◽

Predictive Values ◽

Sensitivity Specificity

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Foundational Statistical Principles in Medical Research: Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value

Medicina ◽

10.3390/medicina57050503 ◽

2021 ◽

Vol 57 (5) ◽

pp. 503

Author(s):

Thomas F. Monaghan ◽

Syed N. Rahman ◽

Christina W. Agudelo ◽

Alan J. Wein ◽

Jason M. Lazar ◽

...

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Medical Literature ◽

Disease Prevalence ◽

Positive Test Result ◽

Predictive Values ◽

Sensitivity Specificity ◽

Test Result ◽

Test Probability

Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion of subjects correctly given a negative assignment out of all subjects who are actually negative for the outcome, indicates how well a test can classify subjects who truly do not have the outcome of interest. Positive predictive value reflects the proportion of subjects with a positive test result who truly have the outcome of interest. Negative predictive value reflects the proportion of subjects with a negative test result who truly do not have the outcome of interest. Sensitivity and specificity are inversely related, wherein one increases as the other decreases, but are generally considered stable for a given test, whereas positive and negative predictive values do inherently vary with pre-test probability (e.g., changes in population disease prevalence). This article will further detail the concepts of sensitivity, specificity, and predictive values using a recent real-world example from the medical literature.

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New screening tool for neonatal nutritional risk in China: a validation study

BMJ Open ◽

10.1136/bmjopen-2020-042467 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042467

Author(s):

Mei Zhou ◽

Yuwei Li ◽

Huaying Yin ◽

Xianhong Zhang ◽

Yan Hu

Keyword(s):

Validation Study ◽

Head Circumference ◽

Predictive Value ◽

Screening Tool ◽

Nutritional Risk ◽

Risk Level ◽

Spearman Correlation ◽

Nutrition Risk ◽

Sensitivity Specificity ◽

Nutritional Risk Screening

ObjectiveA neonatal nutritional risk screening tool (NNRST) was developed by using Delphi and analytic hierarchy processes in China. We verified the accuracy of this tool and analysed whether it effectively screened neonates with nutritional risk.DesignProspective validation study.Setting and participantsIn total, 338 neonates who were admitted to the neonatal unit of Children’s Hospital of Chongqing Medical University from May–July 2016 completed the study. Nutritional risk screening and length and head circumference measurements were performed weekly. Weight was measured every morning, and other relevant clinical data were recorded during hospitalisation.Main outcome measuresWe evaluated the sensitivity, specificity, validity, reliability, and positive and negative predictive value of the screening tool. Various characteristics of neonates in different risk groups were analysed to determine the rationality of the nutritional risk classification.ResultsThe sensitivity, specificity, and positive and negative predictive values were 85.11%, 91.07%, 60.61% and 97.43%, respectively. The criterion validity was texted by the Spearman correlation analysis (r=0.530) and independent samples non-parametric tests (p=0.000). The content validity (Spearman correlation coefficient) was 0.321–0.735. The inter-rater reliability (kappa value) was 0.890. Among the neonatal clinical indicators, gestational age, birth weight, length, admission head circumference, admission albumin, admission total proteins, discharge weight, discharge length and head circumference decreased with increasing nutrition risk level; the length of stay and the rate of parenteral nutrition support increased with increasing nutrition risk level. In the comparison of complications during hospitalisation, the incidence of necrotising enterocolitis and congenital gastrointestinal malformation increased with increasing nutrition risk level.ConclusionThe validation results for the NNRST are reliable. The tool can be used to preliminarily determine the degree of neonatal nutritional risk, but its predictive value needs to be determined in future large-sample studies.Trial registration numberChiCTR2000033743.

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Discriminating levels of alcohol use associated with self-harm in individuals presenting to a district general hospital

The Psychiatrist ◽

10.1192/pb.bp.108.023929 ◽

2010 ◽

Vol 34 (6) ◽

pp. 226-230 ◽

Cited By ~ 1

Author(s):

Nicholas Holdsworth ◽

Hugh Griffiths ◽

David Crawford

Keyword(s):

Alcohol Use ◽

General Hospital ◽

Screening Tool ◽

District General Hospital ◽

Alcohol Screening ◽

Screening Tools ◽

Psychosocial Assessment ◽

Different Types ◽

Self Harm ◽

Problematic Alcohol Use

Aims and methodAlthough alcohol is reported as commonly associated with self-harm, there is nothing in the literature that bases the association on validated screening tools. We sought to discern the different types of alcohol use as discriminated by the Alcohol Use Disorders Identification Test (AUDIT). Completed AUDITs from a 2-year period were analysed, all relating to people who had presented to a district general hospital in Northumberland following self-harm.ResultsThe proportion of dependent, harmful and hazardous drinkers identified using AUDIT was many times higher than previously estimated in similar studies that had not used a validated alcohol screening tool.Clinical implicationsThe routine use of an alcohol screening tool should be part of any standard psychosocial assessment of self-harm, to guide appropriate interventions for problematic alcohol use that might otherwise be overlooked.

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Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in A Poor-Resource Setting

Diagnostics ◽

10.3390/diagnostics9030109 ◽

2019 ◽

Vol 9 (3) ◽

pp. 109 ◽

Cited By ~ 1

Author(s):

Ukweh ◽

Ugbem ◽

Okeke ◽

Ekpo

Keyword(s):

Predictive Value ◽

Performance Metrics ◽

Area Under The Curve ◽

Youden Index ◽

Likelihood Ratios ◽

Diagnostic Efficacy ◽

Predictive Values ◽

Resource Setting ◽

Post Test ◽

Sensitivity Specificity

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

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Prediction of preeclampsia using a combination of serum micro RNA-210 and uterine artery Doppler ultrasound

Science Progress ◽

10.1177/00368504211036856 ◽

2021 ◽

Vol 104 (3) ◽

pp. 003685042110368

Author(s):

Ananya Trongpisutsak ◽

Vorapong Phupong

Keyword(s):

Pregnant Women ◽

Doppler Ultrasound ◽

Predictive Value ◽

Early Onset ◽

Uterine Artery ◽

Micro Rna ◽

Predictive Values ◽

Uterine Artery Doppler ◽

Early Onset Preeclampsia ◽

Sensitivity Specificity

The objective was to determine whether a combination of serum micro RNA-210 level and uterine artery Doppler can predict preeclampsia in pregnant women at 16–24 weeks gestation. A prospective observational study conducted in singleton pregnant women at 16–24 weeks of gestation who had prenatal care at the King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand between 2017 and 2018. Uterine artery Doppler ultrasound and blood testing for serum micro RNA-210 were performed. Pregnancy outcomes were recorded. Optimal cut-off for uterine artery pulsatility index (PI) and serum micro RNA-210 were obtained to calculate the predictive values for preeclampsia. Data from 443 participants were analyzed. Twenty-two cases developed preeclampsia (5.0%) and seven of these preeclamptic cases had early-onset preeclampsia (1.6%). Pregnant women with preeclampsia had higher mean PI of the uterine artery (1.34 ± 0.52 vs 0.98 ± 0.28, p = 0.004), higher detection rates of diastolic notching (45.5% vs 11.2%, p < 0.001), and lower median serum micro RNA-210 level (22.86 vs 795.78, p < 0.001) than pregnant women without preeclampsia. Using abnormal serum micro RNA-210 level, abnormal mean PI or uterine artery diastolic notches to predict for preeclampsia, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 95.5%, 54.9%, 10.0%, and 99.6%, respectively. For early-onset preeclampsia prediction, the sensitivity, specificity, PPV, and NPV were 100.0%, 53.2%, 3.3%, and 100.0%, respectively. This study demonstrated that a combination of serum micro RNA-210 and uterine artery Doppler is effective in predicting preeclampsia in the second trimester.

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Clinical Performance of the Spot Vision Photo Screener before and after Induction of Cycloplegia in Children

Journal of Ophthalmology ◽

10.1155/2019/5329121 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Konuralp Yakar

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Clinical Performance ◽

High Specificity ◽

Screening Criteria ◽

Predictive Values ◽

Before And After ◽

Sensitivity Specificity ◽

Vision Screener

Aim. To compare the clinical performance of the Spot Vision Screener used to detect amblyopia risk factors (ARFs) in children before and after induction of cycloplegia; the children were referred because they met the screening criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Methods. The Spot Vision Screener and a standard autorefractometer were used to examine 200 eyes of 100 children aged 3–10 years, before and after cycloplegia induction, in terms of ARFs. Sensitivity, specificity, and positive and negative predictive values for the detection of significant refractive errors were measured using the AAPOS referral criteria. It was explored that Spot Screener data were affected by cycloplegia. The extent of agreement between cycloplegic/noncycloplegic photoscreening data and cycloplegic autorefraction measurements was assessed using Wilcoxon and Spearman correlation analyses. Results. The Spot’s sensitivity was improved from 60.9% to 85.3% and specificity from 94.9% to 87.4% with cycloplegia compared to cycloplegic standard autorefractometer results. The positive predictive value of Spot was 75.7%, and the negative predictive value was 90.4% without cycloplegia. With cycloplegia, the positive predictive value of Spot was 63.6% and the negative predictive value was 95.8%. Conclusions. The Spot Screener afforded moderate sensitivity and high specificity prior to cycloplegia. The sensitivity and negative predictive value improved after induction of cycloplegia. Examiners should be aware of the effects of cycloplegia on their findings.

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Analytical and Clinical Evaluation of the Automated Elecsys Anti–SARS-CoV-2 Antibody Assay on the Roche cobas e602 Analyzer

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa155 ◽

2020 ◽

Vol 154 (5) ◽

pp. 620-626 ◽

Cited By ~ 3

Author(s):

Clarence W Chan ◽

Kyle Parker ◽

Vera Tesic ◽

Angel Baldwin ◽

Nga Yeung Tang ◽

...

Keyword(s):

Clinical Performance ◽

Population Level ◽

Cross Reactivity ◽

Good Precision ◽

Igg Antibody ◽

Predictive Values ◽

Serologic Testing ◽

Automated Platform ◽

Sensitivity Specificity ◽

Roche Cobas

Abstract Objectives To evaluate the analytical and clinical performance of the automated Elecsys anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody (Elecsys Ab) assay on the Roche cobas e602 analyzer. With the ongoing global coronavirus disease 2019 (COVID-19) pandemic, widespread and routine serologic testing of SARS-CoV-2 remains a pressing need. To better understand its epidemiologic spread and to support policies aimed at curtailing further infections, reliable serologic testing is crucial for providing insight into the dynamics of the spread of COVID-19 on a population level. Methods The presence of anti–SARS-CoV-2 antibodies in polymerase chain reaction–positive, confirmed COVID-19 patient samples was determined using the Elecsys Ab assay on the Roche cobas e602 analyzer. The precision and cross-reactivity of the Elecsys Ab assay were characterized and its performance was compared against the EuroImmun IgA/IgG antibody (EuroImmun Ab) assay. Calculated sensitivity, specificity, and positive and negative predictive values were assessed. Results The Elecsys Ab assay demonstrated good precision, had no cross-reactivity with other viral samples, and showed 100% concordance with the EuroImmun Ab assay. Excellent clinical performance with respect to sensitivity, specificity, and positive and negative predictive values was observed. Conclusions The Elecsys Ab assay is a precise and highly reliable automated platform for clinical detection of seropositivity in SARS-CoV-2 infection.

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An assessment of chromosomal alterations detected by fluorescence in situ hybridisation in pancreatobiliary tract malignancy

BMC Gastroenterology ◽

10.1186/s12876-020-01439-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xiaohong Pu ◽

Hongwei Zheng ◽

Xin Yang ◽

Qing Ye ◽

Zhiwen Fan ◽

...

Keyword(s):

Predictive Value ◽

In Situ Hybridisation ◽

False Negative ◽

Chinese Patients ◽

Fluorescence In Situ Hybridisation ◽

Predictive Values ◽

Formalin Fixed Paraffin Embedded ◽

9P21 Locus ◽

Sensitivity Specificity

Abstract Background Using fluorescence in situ hybridisation (FISH) to detect any gain of chromosomes 3, 7, or 17 and loss of the 9p21 locus has been proven to be sensitive in the diagnosis of pancreatobiliary tumors. However, both genetic and environmental factors contribute to the pathogenesis of pancreatobiliary tumors. Therefore, it is unknown whether this method is suitable for Chinese patients with pancreatobiliary tumors. This study aims to compare the sensitivity, specificity, predictive values and accuracy of cytology, ERCP/MRCP and FISH based on Chinese patients with pancreatobiliary tumors,and to analyze differences between brushing-based and formalin-fixed paraffin-embedded (FFPE)-based FISH. Methods A total of 66 brush cytology specimens obtained during ERCP were detected by FISH and cytology test respectively to compare the sensitivity, specificity, predictive values and accuracy. Besides, FFPE-based FISH was performed on 46 corresponding paraffin sections of pancreatobiliary tumors obtained by surgical resection. Results Our findings demonstrate that FISH greatly improves diagnostic sensitivity and negative predictive value compared to ERCP/MRCP and cytology without much reduction in specificity and positive predictive value. However, our results also indicate that FFPE-based FISH could not effectively identify the false-negative of brushing-based FISH. Conclusions We believe that FISH can effectively distinguish true positive and false positive results of cytological or radiological suspicions of malignancy. However, FFPE-based FISH still does not precisely recognize the false-negative of brushing-based FISH. Both cytology-based and PPFE-based FISH had limitation in some specimens.

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Ultrasound for the diagnosis of gout—the value of gout lesions as defined by the Outcome Measures in Rheumatology ultrasound group

Rheumatology ◽

10.1093/rheumatology/keaa366 ◽

2020 ◽

Vol 60 (1) ◽

pp. 239-249

Author(s):

Sara Nysom Christiansen ◽

Mikkel Østergaard ◽

Ole Slot ◽

Viktoria Fana ◽

Lene Terslev

Keyword(s):

Outcome Measures ◽

Predictive Value ◽

Reference Standards ◽

Secondary Outcome ◽

Predictive Values ◽

Ultrasound Findings ◽

Ultrasound Assessment ◽

Sensitivity Specificity ◽

Ultrasound Group ◽

Msu Crystals

Abstract Objective To evaluate ultrasound for diagnosing gout using consensus-based Outcome Measures in Rheumatology ultrasound definitions of gout lesions. Methods Ultrasound was performed in patients with clinically suspected gout. Joints (28) and tendons (26) were binarily evaluated for the Outcome Measures in Rheumatology gout lesions—double contour (DC), tophus, aggregates and erosions. Ultrasound assessment was compared with two reference standards: (i) presence of MSU crystals in joint/tophus aspirate (primary outcome) and (ii) ACR/EULAR 2015 gout classification criteria (secondary outcome). Both reference standards were evaluated by rheumatologists blinded to ultrasound findings. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of each ultrasound lesion against both reference standards were determined. Results Eighty-two patients (70 men), mean age 62.4 (range 19–88) years, were included. Fifty-seven patients were MSU-positive whereas 25 patients were MSU-negative (no MSU crystals: 23; aspiration unsuccessful: 2). Of these 25 patients, three patients were classified as ACR/EULAR-positive (i.e. totally 60 ACR/EULAR-positive patients). All ultrasound lesions had high sensitivities for gout (0.77–0.95). DC and tophus showed high specificities (0.88–0.95), positive predictive values (0.94–0.98) and accuracies (0.82–0.84) when both reference standards were used. In contrast, low specificities were found for aggregates and erosions (0.32–0.59). Ultrasound of MTP joints for DC or tophus, knee joint for DC and peroneus tendons for tophus was sufficient to identify all MSU-positive patients with ultrasound signs of gout at any location. Conclusion Ultrasound-visualized DC and tophus, as defined by the Outcome Measures in Rheumatology ultrasound group, show high specificities, positive predictive values and accuracies for diagnosing gout and are therefore valid tools in clinical practice.

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