scholarly journals How Helpful Is aEEG? Context and User Experience Matter

2020 ◽  
Author(s):  
Amanda G. Sandoval Karamian ◽  
Courtney J. Wusthoff
Keyword(s):  
Likelihood Ratio ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
Extreme Prematurity ◽  
Clinical Scenarios ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Objective The aim of the study is to model amplitude-integrated electroencephalography (aEEG) utility to diagnose seizures in common clinical scenarios. Study Design Using reported neonatal seizure prevalence and aEEG sensitivities and specificities, likelihood ratios (LRs) and post-test probabilities were calculated to quantify aEEG utility to diagnose seizures in three typical clinical scenarios. Results Prevalence data supported pretest probabilities for neonatal seizures of 0.4 in neonatal hypoxic ischemic encephalopathy (HIE), 0.27 in bacterial meningitis, and 0.05 in extreme prematurity. Reported sensitivity of 85% and specificity of 90% for seizures with expert aEEG interpretation yielded a positive likelihood ratio (LR+) of 8.7 and a negative likelihood ratio (LR−) of 0.17. Reported sensitivity of 65% and specificity of 70% with intermediate interpretation yielded LR+ 2.17 and LR− 0.5. Reported sensitivity of 40% and sensitivity of 50% with inexperienced interpretation gave LR+ 0.8 and LR− 1.2. These translate the ability to move pretest to post-test probability highly dependent on user expertise. For HIE, a pretest probability of seizure of 0.4 moves to a post-test probability of 0.85 when aEEG is positive for seizures by expert interpretation, and down to 0.1 when aEEG is negative. In contrast, no useful information was gained between pretest and post-test probability by aEEG interpreted as negative or positive for seizure at the inexperienced user level. Similarly, in the models of meningitis or extreme prematurity, incremental information gained from aEEG ranged widely based on interpreter experience. Conclusion aEEG is most useful to screen for neonatal seizures when used in conditions with high seizure prevalence, and when interpretation has a sensitivity and specificity as reported for expert users. In contrast, aEEG can become negligible in providing meaningful clinical information when applied in conditions having lower seizure prevalence or when interpretation has low accuracy. Appropriate patient selection and high quality interpretation are essential for aEEG utility in neonatal seizure detection. Key Points

scholarly journals A Mobile Terminal-based Nomogram for Early Predicting Severity of Acute Pancreatitis

2021 ◽  
Author(s):  
Na Shi ◽  
Xiaoxin Zhang ◽  
Wenhua He ◽  
Lihui Deng ◽  
Lan Li ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Prognostic Factors ◽  
Likelihood Ratio ◽  
Clinical Utility ◽  
Negative Likelihood Ratio ◽  
Mobile Terminal ◽  
Prognostic Scores ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Abstract Background: Early prediction of the severity of acute pancreatitis (AP) is important but there is no preferred method in China. We aimed to develop and validate a simple-to-use predictive nomogram for persistent organ failure (POF) on admission in patients with AP. Methods: Data from 816 consecutive patients was obtained from internal (Chengdu) retrospective datasets and formed the training cohort for nomogram development. Data from 398 and 880 consecutive patients from internal (Chengdu) and external (Nanchang) prospective datasets formed the validation cohorts (all admitted < 48 hours of symptom onset). Univariate and multivariate logistic regressions were used to identify independent prognostic factors to establish the nomogram for POF. The calibration curves, concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC) were used to evaluate the performance of the nomogram and its clinical utility. The area under the receiver-operating characteristic curve (AUC) with 95% CI and likelihood ratio as well as post-test probability were applied. Measurements and main results: Age, respiratory rate, albumin, lactate dehydrogenase, oxygen support, and pleural effusion were identified as independent prognostic factors for POF and were included in the nomogram model (web-based calculator: https://shina.shinyapps.io/DynNomapp/). This predictive nomogram had good predictive ability for POF (C-indexes of 0.88, 0.91 and 0.81 for the training and two validation cohorts) and promising clinical utility (DCA: better or equivalent than prognostic scores; CIC: high clinical net benefit). The AUC of (0.91 [0.88-0.94] and 0.81 [0.79-0.84]), negative likelihood ratio (NLR 0.11 and 0.29), post-test probability of negative (0.9% and 6.7%) of the nomogram were superior in predicting POF than all other routinely used clinical prognostic scoring systems in both validation cohorts. Similar findings were observed for predicting major infection (superior to other prognostic scores) and mortality (superior or equally to others). Conclusions: The validated nomogram comprises 6 independent prognostic factors to predict major clinical outcomes of patients with AP in two distinct Chinese centers. This mobile terminal-based nomogram should be validated in other settings and considered for clinical practice and trial allocation, until more accurate biomarkers are discovered.

scholarly journals Ultrasound diagnosis of molar pregnancy

Ultrasound ◽  
2018 ◽  
Vol 26 (3) ◽  
pp. 153-159 ◽  
Author(s):  
Jackie A. Ross ◽  
Alina Unipan ◽  
Jackie Clarke ◽  
Catherine Magee ◽  
Jemma Johns
Keyword(s):  
Likelihood Ratio ◽  
Gestational Trophoblastic Disease ◽  
Ultrasound Diagnosis ◽  
Histopathological Diagnosis ◽  
Molar Pregnancy ◽  
Diagnostic Challenge ◽  
Trophoblastic Disease ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Introduction The primary aims of this study were to establish what proportion of ultrasonically suspected molar pregnancies were proven on histological examination and what proportion of histologically diagnosed molar pregnancies were identified by ultrasound pre-operatively. The secondary aim was to review the features of these scans to help identify criteria that may improve ultrasound diagnosis. Methods This was a retrospective observational study conducted in the Early Pregnancy Unit at King’s College Hospital London over an 11-year period. Cases of ultrasonically suspected molar pregnancy or other gestational trophoblastic disease were identified and compared with the final histopathological diagnosis. In addition, cases which were diagnosed on histopathology that were not suspected on ultrasound were also examined. In discrepant cases, the images were reviewed unblinded by two senior sonographers. Statistical analysis for likelihood ratio and post-test probabilities was performed. Results One hundred eighty-two women had gestational trophoblastic disease suspected on ultrasound examination (1:360, 0.3%); 106/182 (58.2%, 95% CI 51.0 to 65.2%) had histologically confirmed gestational trophoblastic disease. The likelihood ratio for gestational trophoblastic disease after a positive ultrasound was 607.27, with a post-test probability of 0.628.The sensitivity of ultrasound for gestational trophoblastic disease was 70.7% (95% CI 62.9% to 77.4%) with an estimated specificity of 99.88% (95% CI 99.85% to 99.91%); 102/143 (71.3%, 95% CI 63.4 to 78.1%) molar pregnancies were suspected on pre-op ultrasound; 60/68 (88.2%, 95% CI 78.2 to 94.2%) of complete moles were suspected on pre-op ultrasound, compared with 42/75 (56.0%, 95% CI 44.7 to 66.7%) of partial moles. On retrospective review of the pre-op ultrasound images, there were cases that could have been suspected prior to surgery. Conclusion Detecting molar pregnancy by ultrasound remains a diagnostic challenge, particularly for partial moles. These data suggest that there has been an increase in both the predictive value and the sensitivity of ultrasound over time, with a high LR and post-test probability; however, the diagnostic criteria remain ill-defined and could be improved.

scholarly journals Accuracy of closed pleural biopsy in the diagnosis of malignant pleural effusion

2017 ◽  
Vol 43 (6) ◽  
pp. 424-430 ◽  
Author(s):  
Renata Báez-Saldaña ◽  
Uriel Rumbo-Nava ◽  
Araceli Escobar-Rojas ◽  
Patricia Castillo-González ◽  
Santiago León-Dueñas ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Test ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Definitive Diagnosis ◽  
Accuracy Analysis ◽  
Pleural Biopsy ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

ABSTRACT Objective: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. Methods: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. Results: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. Conclusions: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.

scholarly journals Clinical predictors of hypoxemia in pneumonia

2016 ◽  
Vol 43 (5) ◽  
pp. 192
Author(s):  
Eka Gunawijaya ◽  
I M Widia
Keyword(s):  
Developing Countries ◽  
Oxygen Saturation ◽  
Likelihood Ratio ◽  
Causes Of Death ◽  
Clinical Predictors ◽  
Clinical Predictor ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability ◽  
Saturation Measurement

Background Pneumonia is one of the main causes of death ininfants in developing countries. The device of oxygen saturationmeasurement for detecting hypoxemia is limited in district hospi-tals.Objective The aim of our study was to find the best clinical pre-dictor for hypoxemia that could be used in Indonesia.Methods Between June 2001 until May 2002, the diagnostic testwas performed in 125 infants aged 2–12 month-old who sufferedfrom pneumonia. The oxygen saturation measured by pulse oxim-etry was used as the gold standard.Results The samples were divided into two groups, 52 infants withhypoxemia and 73 normal. The base characteristics of both groupswere not statistically different. The prevalence of hypoxemia was41.6%. The best single clinical predictor of hypoxemia was cyano-sis (the sensitivity 92%, specificity 86%, likelihood ratio 6.74, post-test probability 83%), as well as the combination of two clinicalpredictors i.e., cyanosis and nasal flaring. The best combination ofthree clinical predictors was cyanosis, nasal flaring, and refusal todrink (the sensitivity 92%, specificity 86%, likelihood ratio 6.74,post-test probability 81%).Conclusion The combination of cyanosis and nasal flaring isgood enough as a predictor to detect hypoxemia in area with nofacility of oxygen saturation measurement

When should we image our patients? Appropriate use of imaging in inpatient psychiatry

2020 ◽  
pp. 103985622093431
Author(s):  
Malcolm Forbes ◽  
Arjuna Somasundaram ◽  
Karuppiah Jagadheesan ◽  
Stephen Stuckey
Keyword(s):  
Medical Imaging ◽  
Healthcare Costs ◽  
Psychiatric Inpatient ◽  
Appropriate Use ◽  
Inpatient Psychiatry ◽  
Clinical Scenarios ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Objective: Injudicious use of medical imaging may be associated with harm to patients and increased downstream healthcare costs. Guidance on the use of imaging in common psychiatric inpatient scenarios is inconsistent or absent. This paper explores three common clinical scenarios facing adult psychiatrists and provides guidance about the appropriate use of imaging. Conclusion: Psychiatrists and their junior colleagues would benefit from considering both pre- and post-test probability in each presentation.

Diagnostic accuracy of three clinical dehydration scales: a systematic review

2017 ◽  
Vol 103 (4) ◽  
pp. 383-388 ◽  
Author(s):  
Anna Falszewska ◽  
Hania Szajewska ◽  
Piotr Dziechciarz
Keyword(s):  
Diagnostic Accuracy ◽  
Low Income ◽  
Positive Likelihood Ratio ◽  
High Income ◽  
Low Income Countries ◽  
Severe Dehydration ◽  
Post Test ◽  
Sensitivity Specificity ◽  
Post Test Probability ◽  
Test Probability

ObjectiveTo systematically assess the diagnostic accuracy of the Clinical Dehydration Scale (CDS), the WHO Scale and the Gorelick Scale in identifying dehydration in children with acute gastroenteritis (AGE).DesignThree databases, two registers of clinical trials and the reference lists from identified articles were searched for diagnostic accuracy studies in children with AGE. The index tests were the CDS, WHO Scale and Gorelick Scale, and reference standard was the percentage loss of body weight. The main analysed outcomes were the sensitivity, specificity, positive likelihood ratio (LR) and negative LR.ResultsTen studies were included. In high-income countries, the CDS provided a moderate-to-large increase in the post-test probability of predicting moderate to severe (≥6%) dehydration (positive LR 3.9–11.79), but it was of limited value for ruling it out (negative LR 0.55–0.71). In low-income countries, the CDS showed limited value both for ruling in and ruling out moderate-to-severe dehydration. In both settings, the CDS showed poor diagnostic accuracy for ruling in or out no dehydration (<3%) or some dehydration (3%–6%). The WHO Scale showed no or limited value in assessing dehydration in children with diarrhoea. With one exception, the included studies did not confirm the diagnostic accuracy of the Gorelick Scale.ConclusionLimited evidence suggests that the CDS can help in ruling in moderate-to-severe dehydration (≥6%) in high-income settings only. The WHO and Gorelick Scales are not helpful for assessing dehydration in children with AGE.

scholarly journals Predicting Severe/Critical Outcomes in Patients With SARS-CoV2 Pneumonia: Development of the prediCtion seveRe/crItical ouTcome in COVID-19 (CRITIC) Model

2021 ◽  
Vol 8 ◽  
Author(s):  
Fausto Salaffi ◽  
Marina Carotti ◽  
Marco Di Carlo ◽  
Luca Ceccarelli ◽  
Massimo Galli ◽  
...  
Keyword(s):  
Prediction Model ◽  
Severity Score ◽  
Clinical Laboratory ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Predictive Variables ◽  
Post Test ◽  
Comorbidity Index ◽  
Post Test Probability ◽  
Test Probability

Objective: To create a prediction model of the risk of severe/critical disease in patients with Coronavirus disease (COVID-19).Methods: Clinical, laboratory, and lung computed tomography (CT) severity score were collected from patients admitted for COVID-19 pneumonia and considered as independent variables for the risk of severe/critical disease in a logistic regression analysis. The discriminative properties of the variables were analyzed through the area under the receiver operating characteristic curve analysis and included in a prediction model based on Fagan's nomogram to calculate the post-test probability of severe/critical disease. All analyses were conducted using Medcalc (version 19.0, MedCalc Software, Ostend, Belgium).Results: One hundred seventy-one patients with COVID-19 pneumonia, including 37 severe/critical cases (21.6%) and 134 mild/moderate cases were evaluated. Among all the analyzed variables, Charlson Comorbidity Index (CCI) was that with the highest relative importance (p = 0.0001), followed by CT severity score (p = 0.0002), and age (p = 0.0009). The optimal cut-off points for the predictive variables resulted: 3 for CCI [sensitivity 83.8%, specificity 69.6%, positive likelihood ratio (+LR) 2.76], 69.9 for age (sensitivity 94.6%, specificity 68.1, +LR 2.97), and 53 for CT severity score (sensitivity 64.9%, specificity 84.4%, +LR 4.17).Conclusion: The nomogram including CCI, age, and CT severity score, may be used to stratify patients with COVID-19 pneumonia.

Abstract P594: Cardiac Natriuretic Peptides for Diagnosis of Covert AtrialFibrillation After Acute Ischemic Stroke: A Meta-Analysis of Diagnostic Accuracy Studies

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kejia Zhang ◽  
Joseph Kamtchum Tatuene ◽  
Mingxi Li ◽  
Glen C Jickling
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Likelihood Ratio ◽  
Natriuretic Peptides ◽  
Meta Analysis ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Heart Rhythm ◽  
Post Test ◽  
Cardiac Natriuretic Peptides

Background and purpose: Detection of atrial fibrillation (AF) after acute ischemic stroke is pivotal for the timely initiation of anticoagulation to prevent recurrence. Besides heart rhythm monitoring, various blood biomarkers have been suggested as complimentary diagnostic tools for AF. We aimed to summarize data on the performance of cardiac natriuretic peptides for the diagnosis of covert AF after acute ischemic stroke and to assess their potential clinical utility. Methods: We searched PubMed and Embase for prospective studies reporting the performance of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) for the diagnosis of covert AF after acute ischemic stroke. Summary diagnostic performance measures were pooled using bivariate meta-analysis with random-effects model. Results: We included six studies focusing on BNP (n = 1930) and three studies focusing on NT-proBNP (n = 623). BNP had a sensitivity of 0.83 (95% CI: 0.64-0.93), a specificity of 0.74 (0.67-0.81), a positive likelihood ratio of 3.2 (2.6-4.0), and a negative likelihood ratio of 0.23 (0.11-0.49). NT-proBNP had a sensitivity of 0.91 (0.65-0.98), a specificity of 0.77 (0.52-0.91), a positive likelihood ratio of 3.9 (1.8-8.7), and a negative likelihood ratio of 0.12 (0.03-0.48). Considering a pre-test probability of 20%, BNP and NT-proBNP had post-test probabilities of 45% and 50%. Conclusions: NT-proBNP has a better performance than BNP for the diagnosis of covert AF after acute ischemic stroke. Both biomarkers have low post-test probabilities and may not be used as a stand-alone decision-making tool for the diagnosis of covert AF in patients with acute ischemic stroke. However, they may be useful for a screening strategy aiming to select patients for long-term monitoring of the heart rhythm.

scholarly journals Is neutrophil CD11b a special marker for the early diagnosis of sepsis in neonates? A systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e025222 ◽  
Author(s):  
Xia Qiu ◽  
Jinhui Li ◽  
Xiaoyan Yang ◽  
Jun Tang ◽  
Jing Shi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Early Diagnosis ◽  
Likelihood Ratio ◽  
Neonatal Sepsis ◽  
Meta Analysis ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Cochrane Library ◽  
Post Test ◽  
Sensitivity Specificity

ObjectivesOur study aimed to synthesise and analyse the early diagnostic value of neutrophil CD11b (nCD11b) for neonatal sepsis.DesignSystematic review and meta-analysis.MethodsPubmed, Embase, the Cochrane Library and Web of Science Databases were searched up to June 2018. We used Stata software (V.14.0) to conduct the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic OR (DOR), pretest probability, post-test probability and summary receiver operating characteristic (SROC) curve for diagnostic efficiency of n CD11b.ResultsNine studies, accounting for 843 neonates, were included. The overall pooled sensitivity, specificity, PLR, NLR, DOR, post-test positive probability and post-test negative probability and the area under the SROC curve were 0.82 (95% CI 0.71 to 0.90), 0.93 (95% CI 0.62 to 0.99), 11.51 (95% CI 1.55 to 85.62), 0.19 (95% CI 0.10 to 0.36), 59.50 (95% CI 4.65 to 761.58), 74%, 5% and 0.90, which had accuracy in diagnosing neonatal sepsis.ConclusionThe present evidence indicated that nCD11b is a promising biomarker for the early diagnosis of neonatal sepsis.

scholarly journals Cardiac natriuretic peptides for diagnosis of covert atrial fibrillation after acute ischaemic stroke: a meta-analysis of diagnostic accuracy studies

2020 ◽  
pp. svn-2020-000440
Author(s):  
Kejia Zhang ◽  
Joseph Kamtchum-Tatuene ◽  
Mingxi Li ◽  
Glen C. Jickling
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Likelihood Ratio ◽  
Acute Ischaemic Stroke ◽  
Meta Analysis ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Heart Rhythm ◽  
Post Test ◽  
Cardiac Natriuretic Peptides

Background and purposeDetection of atrial fibrillation (AF) after acute ischaemic stroke is pivotal for the timely initiation of anticoagulation to prevent recurrence. Besides heart rhythm monitoring, various blood biomarkers have been suggested as complimentary diagnostic tools for AF. We aimed to summarise data on the performance of cardiac natriuretic peptides for the diagnosis of covert AF after acute ischaemic stroke and to assess their potential clinical utility.MethodsWe searched PubMed and Embase for prospective studies reporting the performance of B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) for the diagnosis of covert AF after acute ischaemic stroke. Summary diagnostic performance measures were pooled using bivariate meta-analysis with a random-effect model.ResultsWe included six studies focusing on BNP (n=1930) and three studies focusing on NT-proBNP (n=623). BNP had a sensitivity of 0.83 (95% CI 0.64 to 0.93), a specificity of 0.74 (0.67 to 0.81), a positive likelihood ratio of 3.2 (2.6 to 4.0) and a negative likelihood ratio of 0.23 (0.11 to 0.49). NT-proBNP had a sensitivity of 0.91 (0.65 to 0.98), a specificity of 0.77 (0.52 to 0.91), a positive likelihood ratio of 3.9 (1.8 to 8.7) and a negative likelihood ratio of 0.12 (0.03 to 0.48). Considering a pretest probability of 20%, BNP and NT-proBNP had post-test probabilities of 45% and 50%.ConclusionsNT-proBNP has a better performance than BNP for the diagnosis of covert AF after acute ischaemic stroke. Both biomarkers have low post-test probabilities and may not be used as a stand-alone decision-making tool for the diagnosis of covert AF in patients with acute ischaemic stroke. However, they may be useful for a screening strategy aiming to select patients for long-term monitoring of the heart rhythm.

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