Accuracy of cardiac auscultation in detection of neonatal congenital heart disease by general paediatricians

AbstractBackground:Challenges remain in the judgement of pathological murmurs in newborns at maternity hospitals, and there are still many simple major CHD patients in developing countries who are not diagnosed in a timely fashion. This study aimed to evaluate the accuracy of cardiac auscultation on neonatal CHD by general paediatricians.Methods:We conducted a prospective study at three hospitals. All asymptomatic newborns underwent auscultation, pulse oximetry monitoring, and echocardiography. Major CHD was classified and confirmed through follow-up. We evaluated the accuracy of various degrees of murmurs for detecting major CHD to determine the most appropriate standards and time of auscultation.Results:A total of 6750 newborns were included. The median age of auscultation was 43 hours. Cardiac murmurs were identified in 6.6% of newborns. For all CHD, 44.4% had varying degrees of murmurs. A murmur of grade ≥2 used as a reference standard for major CHD had a sensitivity of 89.58%. The false positive rate of murmurs of grade ≥2 for detecting major CHD was significantly negatively related to auscultation time, with 84.4% of false positives requiring follow-up for non-major CHD cardiac issues. Auscultation after 27 hours of life could reduce the false positive rate of major CHD from 2.7 to 0.9%.Conclusions:With appropriate training, maternity hospital’s paediatricians can detect major CHD with high detection rates with an acceptable false positive rate.

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Improving diagnosis of acute appendicitis with atypical findings by Tc-99m HMPAO leukocyte scan

Nuklearmedizin ◽

10.1055/s-0038-1623994 ◽

2002 ◽

Vol 41 (01) ◽

pp. 37-41 ◽

Cited By ~ 3

Author(s):

S. Shung-Shung ◽

S. Yu-Chien ◽

Y. Mei-Due ◽

W. Hwei-Chung ◽

A. Kao

Keyword(s):

Acute Appendicitis ◽

False Positive ◽

False Positive Rate ◽

Accurate Method ◽

Clinical Findings ◽

Pathological Findings ◽

Lower Quadrant ◽

Predictive Values ◽

Positive Rate

Summary Aim: Even with careful observation, the overall false-positive rate of laparotomy remains 10-15% when acute appendicitis was suspected. Therefore, the clinical efficacy of Tc-99m HMPAO labeled leukocyte (TC-WBC) scan for the diagnosis of acute appendicitis in patients presenting with atypical clinical findings is assessed. Patients and Methods: Eighty patients presenting with acute abdominal pain and possible acute appendicitis but atypical findings were included in this study. After intravenous injection of TC-WBC, serial anterior abdominal/pelvic images at 30, 60, 120 and 240 min with 800k counts were obtained with a gamma camera. Any abnormal localization of radioactivity in the right lower quadrant of the abdomen, equal to or greater than bone marrow activity, was considered as a positive scan. Results: 36 out of 49 patients showing positive TC-WBC scans received appendectomy. They all proved to have positive pathological findings. Five positive TC-WBC were not related to acute appendicitis, because of other pathological lesions. Eight patients were not operated and clinical follow-up after one month revealed no acute abdominal condition. Three of 31 patients with negative TC-WBC scans received appendectomy. They also presented positive pathological findings. The remaining 28 patients did not receive operations and revealed no evidence of appendicitis after at least one month of follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values for TC-WBC scan to diagnose acute appendicitis were 92, 78, 86, 82, and 90%, respectively. Conclusion: TC-WBC scan provides a rapid and highly accurate method for the diagnosis of acute appendicitis in patients with equivocal clinical examination. It proved useful in reducing the false-positive rate of laparotomy and shortens the time necessary for clinical observation.

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Predicting Fetal Chromosome Anomalies in the First Trimester Using Pregnancy Associated Plasma Protein-A: A Comparison of Statistical Methods

Methods of Information in Medicine ◽

10.1055/s-0038-1634910 ◽

1993 ◽

Vol 32 (02) ◽

pp. 175-179 ◽

Cited By ~ 7

Author(s):

B. Brambati ◽

T. Chard ◽

J. G. Grudzinskas ◽

M. C. M. Macintosh

Keyword(s):

Logistic Regression ◽

General Population ◽

Likelihood Ratio ◽

False Positive ◽

False Positive Rate ◽

Ratio Method ◽

Detection Rates ◽

Gaussian Distributions ◽

Positive Rate ◽

Likelihood Ratio Method

Abstract:The analysis of the clinical efficiency of a biochemical parameter in the prediction of chromosome anomalies is described, using a database of 475 cases including 30 abnormalities. A comparison was made of two different approaches to the statistical analysis: the use of Gaussian frequency distributions and likelihood ratios, and logistic regression. Both methods computed that for a 5% false-positive rate approximately 60% of anomalies are detected on the basis of maternal age and serum PAPP-A. The logistic regression analysis is appropriate where the outcome variable (chromosome anomaly) is binary and the detection rates refer to the original data only. The likelihood ratio method is used to predict the outcome in the general population. The latter method depends on the data or some transformation of the data fitting a known frequency distribution (Gaussian in this case). The precision of the predicted detection rates is limited by the small sample of abnormals (30 cases). Varying the means and standard deviations (to the limits of their 95% confidence intervals) of the fitted log Gaussian distributions resulted in a detection rate varying between 42% and 79% for a 5% false-positive rate. Thus, although the likelihood ratio method is potentially the better method in determining the usefulness of a test in the general population, larger numbers of abnormal cases are required to stabilise the means and standard deviations of the fitted log Gaussian distributions.

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Impact of Including or Removing Nuchal Translucency Measurement on the Detection and False-Positive Rates of First-Trimester Down Syndrome Screening

Fetal Diagnosis and Therapy ◽

10.1159/000442198 ◽

2015 ◽

Vol 40 (3) ◽

pp. 214-218 ◽

Cited By ~ 1

Author(s):

Emmanuel Spaggiari ◽

Isabelle Czerkiewicz ◽

Corinne Sault ◽

Sophie Dreux ◽

Armelle Galland ◽

...

Keyword(s):

Down Syndrome ◽

False Positive ◽

False Positive Rate ◽

Method Comparison ◽

First Trimester ◽

Nuchal Translucency ◽

Routine Practice ◽

Detection Rates ◽

Significant Difference ◽

Positive Rate

Introduction: First-trimester Down syndrome (DS) screening combining maternal age, serum markers (pregnancy-associated plasma protein-A and beta-human chorionic gonadotropin) and nuchal translucency (NT) gives an 85% detection rate for a 5% false-positive rate. These results largely depend on quality assessment of biochemical markers and of NT. In routine practice, despite an ultrasound quality control organization, NT images can be considered inadequate. The aim of the study was to evaluate the consequences for risk calculation when NT measurement is not taken into account. Material and Method: Comparison of detection and false-positive rates of first-trimester DS screening (PerkinElmer, Turku, Finland), with and without NT, based on a retrospective study of 117,126 patients including 274 trisomy 21-affected fetuses. NT was measured by more than 3,000 certified sonographers. Results: There was no significant difference in detection rates between the two strategies including or excluding NT measurement (86.7 vs. 81.8%). However, there was a significant difference in the false-positive rates (2.23 vs. 9.97%, p < 0.001). Discussion: Sonographers should be aware that removing NT from combined first-trimester screening would result in a 5-fold increase in false-positive rate to maintain the expected detection rates. This should be an incentive for maintaining quality in NT measurement.

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Data Authentication for Wireless Sensor Networks with High Detection Efficiency Based on Reversible Watermarking

Wireless Communications and Mobile Computing ◽

10.1155/2021/6651137 ◽

2021 ◽

Vol 2021 ◽

pp. 1-13

Author(s):

Guangyong Gao ◽

Zhao Feng ◽

Tingting Han

Keyword(s):

Wireless Sensor Networks ◽

False Positive ◽

Detection Efficiency ◽

False Positive Rate ◽

Reversible Watermarking ◽

Wireless Sensor ◽

Data Authentication ◽

High Detection ◽

High Detection Efficiency ◽

Positive Rate

Data authentication is an important part of wireless sensor networks (WSNs). Aiming at the problems of high false positive rate and poor robustness in group verification of existing reversible watermarking schemes in WSNs, this paper proposes a scheme using reversible watermarking technology to achieve data integrity authentication with high detection efficiency (DAHDE). The core of DAHDE is dynamic grouping and double verification algorithm. Under the condition of satisfying the requirement of the group length, the synchronization point is used for dynamic grouping, and the double verification ensures that the grouping will not be confused. According to the closely related characteristics of adjacent data in WSNs, a new data item prediction method is designed based on the prediction-error expansion formula, and a flag check bit is added to the data with embedded watermarking during data transmission to ensure the stability of grouping, by which the fake synchronization point can be accurately identified. Moreover, the embedded data can be recovered accurately through the reversible algorithm of digital watermarking. Analysis and experimental results show that compared with the previously known schemes, the proposed scheme can avoid false positive rate, reduce computation cost, and own stronger grouping robustness.

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The efficacy of combining several risk factors as a screening test

Journal of Medical Screening ◽

10.1258/096914105775220642 ◽

2005 ◽

Vol 12 (4) ◽

pp. 197-201 ◽

Cited By ~ 37

Author(s):

Nicholas J Wald ◽

Joan K Morris ◽

Simon Rish

Keyword(s):

Risk Factors ◽

Risk Factor ◽

False Positive ◽

Detection Rate ◽

False Positive Rate ◽

Individual Risk ◽

Detection Rates ◽

Screening Performance ◽

Positive Rate ◽

The Individual

Objective: To determine the quantitative effect on overall screening performance (detection rate for a given false-positive rate) of using several moderately strong, independent risk factors in combination as screening markers. Setting: Theoretical statistical analysis. Methods: For the purposes of this analysis, it was assumed that all risk factors were independent, had Gaussian distributions with the same standard deviation in affected and unaffected individuals and had the same screening performance. We determined the overall screening performance associated with using an increasing number of risk factors together, with each risk factor having a detection rate of 10%, 15% or 20% for a 5% false-positive rate. The overall screening performance was estimated as the detection rate for a 5% false-positive rate. Results: Combining the risk factors increased the screening performance, but the gain in detection at a constant false-positive rate was relatively modest and diminished with the addition of each risk factor. Combining three risk factors, each with a 15% detection rate for a 5% false-positive rate, yields a 28% detection rate. Combining five risk factors increases the detection rate to 39%. If the individual risk factors have a detection rate of 10% for a 5% false-positive rate, it would require combining about 15 such risk factors to achieve a comparable overall detection rate (41%). Conclusion: It is intuitively thought that combining moderately strong risk factors can substantially improve screening performance. For example, most cardiovascular risk factors that may be used in screening for ischaemic heart disease events, such as serum cholesterol and blood pressure, have a relatively modest screening performance (about 15% detection rate for a 5% false-positive rate). It would require the combination of about 15 or 20 such risk factors to achieve detection rates of about 80% for a 5% false-positive rate. This is impractical, given the risk factors so far discovered, because there are too few risk factors and their associations with disease are too weak.

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LOW FALSE POSITIVE RATE OFKEPLERCANDIDATES ESTIMATED FROM A COMBINATION OFSPITZERAND FOLLOW-UP OBSERVATIONS

The Astrophysical Journal ◽

10.1088/0004-637x/804/1/59 ◽

2015 ◽

Vol 804 (1) ◽

pp. 59 ◽

Cited By ~ 33

Author(s):

Jean-Michel Désert ◽

David Charbonneau ◽

Guillermo Torres ◽

François Fressin ◽

Sarah Ballard ◽

...

Keyword(s):

False Positive ◽

False Positive Rate ◽

Positive Rate

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Using Z-score to optimize population-specific DDH screening: a retrospective study in Hangzhou, China

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04216-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Haomin Li ◽

Liqi Shu ◽

Jin Yu ◽

Zeng Xian ◽

Huilong Duan ◽

...

Keyword(s):

False Positive ◽

False Positive Rate ◽

Developmental Dysplasia ◽

Z Score ◽

Local Regression ◽

X Ray ◽

Positive Rate ◽

Z Scores ◽

Highly Correlated

Abstract Background DDH (Developmental Dysplasia of the Hip) screening can potentially avert many morbidities and reduce costs. The debate about universal vs. selective DDH ultrasonography screening in different countries revolves to a large extent around effectiveness, cost, and the possibility of overdiagnosis and overtreatment. In this study, we proposed and evaluated a Z-score enhanced Graf method to optimize population-specific DDH screening. Methods A total of 39,710 history ultrasonography hip examinations were collected to establish a sex, side specific and age-based Z-scores model using the local regression method. The correlation between Z-scores and classic Graf types was analyzed. Four thousand two hundred twenty-nine cases with follow-up ultrasonographic examinations and 5284 cases with follow-up X-ray examinations were used to evaluate the false positive rate of the first examination based on the subsequent examinations. The results using classic Graf types and the Z-score enhanced types were compared. Results The Z-score enhanced Graf types were highly correlated with the classic Graf’s classification (R = 0.67, p < 0.001). Using the Z-scores ≥2 as a threshold could reduce by 86.56 and 80.44% the false positives in the left and right hips based on the follow-up ultrasonographic examinations, and reduce by 78.99% false-positive cases based on the follow-up X-ray examinations, respectively. Conclusions Using an age, sex and side specific Z-scores enhanced Graf’s method can better control the false positive rate in DDH screening among different populations.

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Follow-Up SARS-CoV-2 PCR Testing Outcomes From a Large Reference Lab in the US

Frontiers in Public Health ◽

10.3389/fpubh.2021.679012 ◽

2021 ◽

Vol 9 ◽

Author(s):

Adam Sullivan ◽

David Alfego ◽

Brian Poirier ◽

Jonathan Williams ◽

Dorothy Adcock ◽

...

Keyword(s):

United States ◽

Cohort Study ◽

False Positive ◽

False Positive Rate ◽

The United States ◽

Positive Test ◽

Test Results ◽

Rt Pcr ◽

Positive Rate

By analyzing COVID-19 sequential COVID-19 test results of patients across the United States, we herein attempt to quantify some of the observations we've made around long-term infection (and false-positive rates), as well as provide observations on the uncertainty of sampling variability and other dynamics of COVID-19 infection in the United States. Retrospective cohort study of a registry of RT-PCR testing results for all patients tested at any of the reference labs operated by Labcorp® including both positive, negative, and inconclusive results, from March 1, 2020 to January 28, 2021, including patients from all 50 states and outlying US territories. The study included 22 million patients with RT-PCR qualitative test results for SARS-CoV-2, of which 3.9 million had more than one test at Labcorp. We observed a minuscule <0.1% basal positive rate for follow up tests >115 days, which could account for false positives, long-haulers, and/or reinfection but is indistinguishable in the data. In observing repeat-testing, for patients who have a second test after a first RT-PCR, 30% across the cohort tested negative on the second test. For patients who test positive first and subsequently negative within 96 h (40% of positive test results), 18% of tests will subsequently test positive within another 96-h span. For those who first test negative and then positive within 96 h (2.3% of negative tests), 56% will test negative after a third and subsequent 96-h period. The sudden changes in RT-PCR test results for SARS-CoV-2 from this large cohort study suggest that negative test results during active infection or exposure can change rapidly within just days or hours. We also demonstrate that there does not appear to be a basal false positive rate among patients who test positive >115 days after their first RT-PCR positive test while failing to observe any evidence of widespread reinfection.

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Follow‐up program for blood donors with unconfirmed screening results reveals a high false‐positive rate in Dalian, China

Transfusion ◽

10.1111/trf.15656 ◽

2020 ◽

Vol 60 (2) ◽

pp. 334-342

Author(s):

Xuelian Deng ◽

Liang Zang ◽

Xinmei Wang ◽

Hui Chen ◽

Jiangdi Liu ◽

...

Keyword(s):

False Positive ◽

Blood Donors ◽

False Positive Rate ◽

High False Positive Rate ◽

Positive Rate

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How Effective Is First-Trimester Screening for Trisomy 21 Based on Ultrasound Only?

Fetal Diagnosis and Therapy ◽

10.1159/000434632 ◽

2015 ◽

Vol 39 (2) ◽

pp. 105-112 ◽

Cited By ~ 4

Author(s):

Marcin Wiechec ◽

Anna Knafel ◽

Agnieszka Nocun ◽

Anna Matyszkiewicz ◽

Magdalena Juszczak ◽

...

Keyword(s):

Trisomy 21 ◽

False Positive Rate ◽

First Trimester ◽

Nuchal Translucency ◽

Cardiac Anomaly ◽

Screening Methods ◽

Detection Rates ◽

Comparable Performance ◽

Positive Rate ◽

A Prospective Study

Objective: To evaluate the most common first-trimester ultrasound features of fetuses with trisomy 21 (T21) and to examine the screening performance for Down syndrome (DS) using only ultrasound-based protocols. To investigate whether maternal age (MA) has an impact on the efficacy of the ultrasound-based screening methods. Methods: In a prospective study, 6,265 patients were examined. Two ultrasound-based risk calculation protocols were applied: ‘NT' (based on nuchal translucency) and ‘NT+' (based on NT and secondary markers). Results: A total of 5,696 patients were enrolled for analysis; 84 subjects with T21 were identified. Combinations of abnormal ultrasound markers were observed in only 1.2% of euploid fetuses compared to 71.5% of fetuses with T21. Among 17.9% of DS cases with cardiac anomaly, 14.3% comprised atrioventricular septal defects. For a false-positive rate of 3%, the detection rates of T21 were 73.8 and 91.7% for the ‘NT' and ‘NT+' protocols, respectively. The efficacy of both methods was affected by MA. Conclusions: Most of the fetuses with DS demonstrate a combination of ultrasound markers of aneuploidy in the first trimester. The ‘NT+' protocol is efficient and provides comparable performance as a combined screening test. It is a valuable method, especially when the access to biochemical analysis is restricted.

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