Reassessment of the CAGE questionnaire by ROC/Taguchi methods

2004 ◽  
Vol 20 (2) ◽  
pp. 242-246 ◽  
Author(s):  
Mehmet Tolga Taner ◽  
Jiju Antony
Keyword(s):  
Alcohol Abuse ◽  
Diagnostic Accuracy ◽  
Problem Drinking ◽  
General Medicine ◽  
Roc Curves ◽  
Taguchi Methods ◽  
Trade Offs ◽  
Dependent Relation ◽  
Cage Questionnaire ◽  
Treatment Settings

Objectives: The clinical assessment efficiency of the CAGE questionnaire for alcohol abuse based on diagnostic accuracy has not been fully established to date because of the varied and inconclusive gold standards used as diagnostic criteria. CAGE has also been highlighted to miss almost half of the risk-drinkers due to the use of inadequetly set criteria for the positive recognition of alcohol abuse. This study aims to establish the diagnostic accuracy of CAGE at different treatment settings.Methods: A hybrid of the receiver operating characteristic (ROC) and the Taguchi method was used, as this approach proved to evaluate the diagnostic performance and accuracy in hypothetical clinical settings. Data were used from three cross-clinical treatment settings, i.e., general medicine outpatients, medical inpatients, and psychiatric inpatients, and analyzed by means of a step-wise application of managable number of statistical indices such as the area under the ROC curve (AUC), leveling factor (p′), and signal-to-noise ratios (S/N; standardized S/N [SS/N]).Results: The selected settings yielded similar AUCs but portrayed different trade-offs on the ROC curves signaling the presence of different critical CAGE scores. Analysis of the sensitivity and specificity data of i, ii, iii by p′, S/N, SS/N and their dependent relation resulted in the critical CAGE scores of 1,1, and 2; and high diagnostic accuracy levels of 76.84 percent, 86 percent, and 76.84 percent, respectively.Conclusions: By setting these critical CAGE scores as the minimum detection levels of alcohol abuse, early intervention before the onset of serious alcohol-related problems is possible. This will decrease the health-care costs of the patient and, in addition, reduce the psychological and social burdens inherent to alcohol abuse both on the patient and society. Having its critical scores reliably identified and diagnostic accuracy fully determined, CAGE can now improve the detection rate of problem drinking individuals substantially.

Comparison of diagnostic accuracy of 18F-FDG PET, 123I-IMT- and 99mTc-MIBI SPECT

2006 ◽  
Vol 45 (01) ◽  
pp. 49-56 ◽  
Author(s):  
N. Özdemir-Sahin ◽  
P. Hipp ◽  
W. Mier ◽  
M. Eisenhut ◽  
J. Debus ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Fdg Pet ◽  
Tumour Progression ◽  
Roc Curves ◽  
Low Grade ◽  
Who Grade ◽  
Pet Tracer ◽  
Patient Groups ◽  
99Mtc Mibi ◽  
Mibi Spect

Summary Aim was to evaluates the diagnostic accuracy of the SPECTtracers 3-123I-α-methyl-L-tyrosine (IMT) and 99mTc(I)- hexakis(2-methoxyisobutylisonitrile) (MIBI) as well as the PET-tracer 2-18F-2-deoxyglucose (FDG) for detecting tumour progression in irradiated low grade astrocytomas (LGA). Patients, methods: We examined 91 patients (56 males; 35 females; 44.7 ± 11.5 years), initially suffering from histologically proven LGAs (mean WHO grade II) and treated by stereotactic radiotherapy (59.0 ± 4.6 Gy). On average 21.9 ± 11.2 months after radiotherapy, patients presented new Gd-DTPA enhancing lesions on MRI, which did not allow a differentiation between progressive tumour (PT) and non-PT (nPT) at this point of time. PET scans (n=82) were acquired 45 min after injection of 208 ± 32 MBq FDG. SPECT scans started 10 min after injection of 269 ± 73 MBq IMT (n=68) and 15 min after injection of 706 ± 63 MBq MIBI (n=34). Lesions were classified as PT and nPT based on prospective follow-up (clinically, MRI) for 17.2 ± 9.9 months after PET/SPECT. Lesion-to-normal ratios (L/N) were calculated using contra lateraly mirrored reference regions for the SPECT examinations and reference regions in the contra lateral grey (GM) and white matter (WM) for FDG PET. Ratios were evaluated by Receiver Operating Characteristic (ROC) analysis. Results: In the patient groups nPT and PT, L/N ratios for FDG (GS) were 0.6 ± 0.3 vs. 1.2 ± 0.5 (p = 0.003), for FDG (WS) 1.2 ± 0.4 vs. 2.6 ± 0.4 (p <0.001), for IMT 1.1 ± 0.1 vs. 1.8 ± 0.4 (p <0.001) and for MIBI 1.6 ± 0.7 vs. 2.6 ± 2.2 (p = 0.554). Areas under the non-parametric ROC-curves were: 0.738 ± 0.059 for FDG (GS), 0.790 ± 0.057 for FDG (WS), 0.937 ± 0.037 for IMT and 0.564 ± 0.105 for MIBI. Conclusion: MIBI-SPECT examinations resulted in a low accuracy and especially in a poor sensitivity even at modest specificity values. A satisfying diagnostic accuracy was reached with FDG PET. Using WM as reference region for FDG PET, a slightly higher AUC as compared to GM was calculated. IMT yielded the best ROC characteristics and the highest diagnostic accuracy for differentiating between PT and nPT in irradiated LGA.

Diagnostic accuracy of enthesis ultrasound in the diagnosis of early spondyloarthritis

2010 ◽  
Vol 70 (3) ◽  
pp. 434-439 ◽  
Author(s):  
Eugenio de Miguel ◽  
Santiago Muñoz-Fernández ◽  
Concepción Castillo ◽  
Tatiana Cobo-Ibáñez ◽  
Emilio Martín-Mola
Keyword(s):  
New York ◽  
Diagnostic Accuracy ◽  
Statistical Significance ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Controlled Study ◽  
Diagnostic Classification ◽  
Hla B27 ◽  
Cross Sectional ◽  
Ultrasound Score

ObjectiveTo determine the sensitivity and specificity of enthesis ultrasound for the diagnostic classification of early spondyloarthritis.MethodsA cross-sectional, blinded and controlled study. Standardised bilateral ultrasound of six entheses (Madrid sonography enthesitis index (MASEI)) was performed. Accepted diagnostic classification criteria were used as the gold standard. Validity was analysed by receiver operating characteristic (ROC) curves. Values of p<0.05 were considered significant.Results113 early spondyloarthritis patients were included (58 women/55 men), 57 non-inflammatory control individuals (29 women/28 men) and 24 inflammatory control individuals (11 women/13 men). The evolution time of spondyloarthritis was 10.9±7.1 months. At least some grade of sacroiliitis on x-ray was present in 59 patients, but only five fulfilled the radiographic sacroiliitis New York criteria. Human leucocyte antigen B27 (HLA-B27) was positive in 42% of patients. No statistical differences were found for the enthesis score among diagnostic spondyloarthritis subtypes form of presentation (axial, peripheral or mixed) or HLA-B27 positivity. The MASEI score achieved statistical significance for gender. The ultrasound score was 23.36±11.40 (mean±SD) in spondyloarthritis patients and 12.26±6.85 and 16.04±9.94 in the non-inflammatory and inflammatory control groups (p<0.001), respectively. The ROC area under the curve was 0.82, and a cut-off point of ≥20 points achieved a likelihood ratio of 5.30 and a specificity of 89.47%.ConclusionsEntheses are affected early in spondyloarthritis, and the incidence of involvement is higher in men and independent of the spondyloarthritis diagnostic subtype, HLA-B27 status or presentation pattern. The enthesis ultrasound score seems to have diagnostic accuracy and may be useful for improving the diagnostic accuracy of early spondyloarthritis.

scholarly journals Diagnostic accuracy of anthropometric indices in predicting excess body fat among seven to ten-year-old children

2014 ◽  
Vol 17 (1) ◽  
pp. 243-254 ◽  
Author(s):  
Edineia Aparecida Gomes Ribeiro ◽  
Danielle Biazzi Leal ◽  
Maria Alice Altenburg de Assis
Keyword(s):  
Diagnostic Accuracy ◽  
Body Fat ◽  
Roc Curves ◽  
Cross Sectional Study ◽  
The Body ◽  
Anthropometric Indices ◽  
Cross Sectional ◽  
Standardized Residuals ◽  
Highly Sensitive ◽  
Anthropometric Index

PURPOSE: To evaluate the accuracy of the body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) in detecting excess body fat among schoolchildren in Florianópolis, Santa Catarina. METHODS: Cross-sectional study with 2,772 schoolchildren aged seven to ten years. Receiver Operating Characteristic (ROC) curves were used to compare the diagnostic accuracy of the BMI, the WC and the WHtR in identifying children with excess body fat (defined as values that were equal to or higher than the 90th percentile of the standardized residuals obtained from the sum of the four skinfolds thickness). Likelihood ratio estimates were used to select, for each anthropometric index, the cut-off points that presented the highest association with excess body fat. RESULTS: The BMI, WC and WHtR performed well in detecting excess body fat, indicated by areas under the ROC curve (AUC) close to 1.0, with slightly higher AUC for the BMI in comparison to the WC and the WHtR concerning both sexes. Highly sensitive and specific cut-off points were derived for the three anthropometric indices. Sensitivity ranged from 85.7 to 92.9% for the BMI, from 78.6 to 89.7% for the WC, and from 78.6 to 89.2% for the WHtR. Specificity ranged from 83.2 to 91.4%, from 75.0 to 90.7%, and from 77.4 to 88.3% for the BMI, the WC and the WHtR, respectively. CONCLUSION: BMI, WC and WHtR can be used as diagnostic tests to identify excess body fat in children from seven to ten years of age.

scholarly journals Cost-Saving Early Diagnosis of Functional Pain in Nonmalignant Pain: A Noninferiority Study of Diagnostic Accuracy

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Rafael J. A. Cámara ◽  
Christian Merz ◽  
Barbara Wegmann ◽  
Stefanie Stauber ◽  
Roland von Känel ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Cost Saving ◽  
Diagnostic Accuracy ◽  
Pain Perception ◽  
Diagnostic Testing ◽  
Roc Curves ◽  
University Hospital ◽  
Screening Tests ◽  
Functional Pain ◽  
Specialized Equipment

Objectives. We compared two index screening tests for early diagnosis of functional pain: pressure pain measurement by electronic diagnostic equipment, which is accurate but too specialized for primary health care, versus peg testing, which is cost-saving and more easily manageable but of unknown sensitivity and specificity. Early distinction of functional (altered pain perception; nervous sensitization) from neuropathic or nociceptive pain improves pain management. Methods. Clinicians blinded for the index screening tests assessed the reference standard of this noninferiority diagnostic accuracy study, namely, comprehensive medical history taking with all previous findings and treatment outcomes. All consenting patients referred to a university hospital for nonmalignant musculoskeletal pain participated. The main analysis compared the receiver operating characteristic (ROC) curves of both index screening tests. Results. The area under the ROC curve for peg testing was not inferior to that of electronic equipment: it was at least 95% as large for finger measures (two-sided p=0.038) and at least equally as large for ear measures (two-sided p=0.003). Conclusions. Routine diagnostic testing by peg, which is accessible for general practitioners, is at least as accurate as specialized equipment. This may shorten time-to-treatment in general practices, thereby improving the prognosis and quality of life.

scholarly journals Step-count guidelines referenced on 60-minutes of moderate/vigorous physical activity

2015 ◽  
Vol 21 (1) ◽  
pp. 92-99
Author(s):  
Fabio Eduardo Fontana ◽  
Michael Pereira da Silva ◽  
Ripley Marston ◽  
Kevin Finn ◽  
Jere Gallagher
Keyword(s):  
Physical Activity ◽  
Diagnostic Accuracy ◽  
Vigorous Physical Activity ◽  
Roc Curves ◽  
Sixth Grade ◽  
Step Count ◽  
Step Counts ◽  
Sixth Grade Students ◽  
Good Diagnostic Accuracy ◽  
Full Day

The purpose of this study was to establish step-count guidelines for sixth-grade students and assess the ability of step-counts to discriminate between students achieving and not achieving 60-minutes of moderate to vigorous physical activity daily. 201 sixth-grade students completed the study. They wore a pedometer and an accelerometer at the waist level for one full day. ROC curves were used to establish step-count guidelines and determine the diagnostic accuracy of step-counts. Sixth grade students need 12,118 steps/day to reach adequate daily levels of physical activity. The AUC indicated good diagnostic accuracy of step-counts. Suggested step-count guidelines can be a useful tool for identifying children who need to increase their daily levels of physical activity. The step-count cutoff proposed in this study is adequate for discriminating between sixth grade students reaching and not reaching recommended levels of physical activity.

scholarly journals Parental alcohol abuse and eating behaviors in adolescents

2015 ◽  
Vol 125 (4) ◽  
pp. 194-196
Author(s):  
Anna Cur ◽  
Kinga Szymona ◽  
Marek Domański ◽  
Aneta Opolska ◽  
Mariusz Jojczuk
Keyword(s):  
Eating Disorders ◽  
Alcohol Abuse ◽  
Eating Behaviors ◽  
Mental Health Problems ◽  
Preventive Measures ◽  
Problem Drinking ◽  
Eating Disorder Inventory ◽  
The Family ◽  
Future Work ◽  
Parental Alcohol

AbstractIntroduction.Parental alcohol abuse hinders a child’s development, which means that these children are more exposed to mental health problems.Aim.The aim of this study was to analyze the link between the intensity of eating disorders in youngsters and family alcoholism.Material and methods.The study was conducted among adolescents in the Lubelskie province. 1766 students, aged 12 to 22 were participants in the study. The authors used a method called Eating Disorder Inventory, as well as a self-designed questionnaire that included assessing the characteristics of every family.Results.The findings of this study show that increased symptoms of eating disorders in children and teenagers correlates with alcohol dependency in the family. Adolescent children of alcoholics have higher levels of conflict identifying feelings and emotions (hunger, security) correctly. They were more likely to deem their actions as ineffective, as well as they were more frequently prone to binge eating than individuals who were not affected by drinking parents.Conclusions.There is a need for some future work and preventive measures to be taken in families affected by problem drinking.

A non-inferiority test for diagnostic accuracy based on the paired partial areas under ROC curves

2008 ◽  
Vol 27 (10) ◽  
pp. 1762-1776 ◽  
Author(s):  
Chi-Rong Li ◽  
Chen-Tuo Liao ◽  
Jen-Pei Liu
Keyword(s):  
Diagnostic Accuracy ◽  
Roc Curves

scholarly journals Early detection of peritonitis in continuous ambulatory peritoneal dialysis patients by use of chemiluminescence: evaluation of diagnostic accuracy by receiver-operating characteristic curve analysis

1998 ◽  
Vol 44 (8) ◽  
pp. 1680-1684 ◽  
Author(s):  
Gönül Dalaman ◽  
Goncagül Haklar ◽  
Armand Sipahiu ◽  
Çetin Özener ◽  
Emel Akoĝlu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Diagnostic Accuracy ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Characteristic Curve ◽  
Major Complication ◽  
Roc Curves ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Oxidative Potential ◽  
Susceptibility To Infection

Abstract Continuous ambulatory peritoneal dialysis (CAPD) is now a widely accepted treatment for end-stage renal disease. However, the high incidence of peritonitis is a major complication of CAPD. Polymorphonuclear leukocytes (PMNs) play a major role in antimicrobial response of the host. During phagocytosis, the PMNs undergo a striking increase in oxidative metabolism, known as the respiratory burst, and emit light as chemiluminescence (CL). CL is thus a sensitive measure of PMN oxidative potential and correlates well with antimicrobial activity. In view of the observation of increased susceptibility to infection in CAPD patients, we have studied lucigenin- and luminol-enhanced CL in peritoneal fluids of these patients and assessed the diagnostic accuracy of these tests by ROC curve analysis. ROC curves showed diagnostic accuracies for both tests that were superior to counts of PMNs in the dialysis fluid (P &lt;0.001). At selected cutoff values of 150 000 cpm/vial for lucigenin CL and 600 000 cpm/vial for luminol CL, sensitivities were 100%. Specificities for lucigenin and luminol CL were 89% and 80%, respectively. Our results suggest that CL measurements can be used as an early marker for the presence of infection in CAPD patients.

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