Comparison of diagnostic likelihood ratios of two binary tests with case-control clustered data

5563 Background: Urinary HE4 has been reported as a promising biomarker for ovarian cancer (OC). In the current study, a large validation was performed to evaluate urinary HE4 as a biomarker for the stratification of OC from benign pelvic masses. Methods: Normalized HE4 was obtained from the ratio of HE4 (pmol/L measured with HE4 EIA) and creatinine (mg/dL measured with a Jaffe Reaction) in single-point urine samples from female subjects with a pelvic mass (N = 809). The samples were from one case-control prospective study (Moore RG, 2008) and two prospective clinical trials (NCT00315692 and NCT00987649). R Package was used to randomly distribute the subjects into the Training and Testing Sets. Analyze-it was used to analyze the clinical performance. Results: Medians of Normalized HE4, sensitivities (SN) and likelihood ratios (LR) (+) of Normalized HE4 at two levels of specificity (SP) are presented in the Table. Conclusions: Urinary HE4 normalized with urinary creatinine appears to be a valid biomarker for the stratification of OC from a benign pelvic mass. [Table: see text]

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Height of fever and invasive bacterial infection

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-318548 ◽

2020 ◽

pp. archdischild-2019-318548

Author(s):

Kenneth A Michelson ◽

Mark I Neuman ◽

Christopher M Pruitt ◽

Sanyukta Desai ◽

Marie E Wang ◽

...

Keyword(s):

Bacterial Infection ◽

Case Control Study ◽

Secondary Analysis ◽

Case Control ◽

Maximum Temperature ◽

Likelihood Ratios ◽

Invasive Bacterial Infection ◽

Maximum Temperatures ◽

Half Degree ◽

Control Study

ObjectiveWe aimed to evaluate the association of height of fever with invasive bacterial infection (IBI) among febrile infants <=60 days of age.MethodsIn a secondary analysis of a multicentre case–control study of non-ill-appearing febrile infants <=60 days of age, we compared the maximum temperature (at home or in the emergency department) for infants with and without IBI. We then computed interval likelihood ratios (iLRs) for the diagnosis of IBI at each half-degree Celsius interval.ResultsThe median temperature was higher for infants with IBI (38.8°C; IQR 38.4–39.2) compared with those without IBI (38.4°C; IQR 38.2–38.9) (p<0.001). Temperatures 39°C–39.4°C and 39.5°C–39.9°C were associated with a higher likelihood of IBI (iLR 2.49 and 3.40, respectively), although 30.4% of febrile infants with IBI had maximum temperatures <38.5°C.ConclusionsAlthough IBI is more likely with higher temperatures, height of fever alone should not be used for risk stratification of febrile infants.

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Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case–control study

Acta Endocrinologica ◽

10.1530/eje-14-0481 ◽

2014 ◽

Vol 171 (5) ◽

pp. 593-602 ◽

Cited By ~ 29

Author(s):

Allan Carlé ◽

Inge Bülow Pedersen ◽

Nils Knudsen ◽

Hans Perrild ◽

Lars Ovesen ◽

...

Keyword(s):

Population Based ◽

Case Control ◽

Overt Hypothyroidism ◽

Likelihood Ratios ◽

Dry Skin ◽

Population Based Study ◽

Autoimmune Hypothyroidism ◽

Component Score ◽

Post Test ◽

The Individual

BackgroundIt is generally accepted that patients suffering from hypothyroidism may express few symptoms, but this has not been studied in a population-based study design.ObjectivesTo study the array of symptoms as they are reported in newly diagnosed overt autoimmune hypothyroidism using a population-based case–control design.MethodsPatients with new overt autoimmune hypothyroidism (n=140) and their individually matched thyroid disease-free controls (n=560) recruited from the same population underwent a comprehensive program and self-reported a number of symptoms. We identified the symptoms associated with overt hypothyroidism and calculated positive (LR+) and negative (LR−) likelihood ratios as well as diagnostic odds ratios (DORs) as measures for the association between disease state and symptoms.ResultsAmong 34 symptoms investigated, 13 symptoms were statistically overrepresented in hypothyroidism. Hypothyroid patients suffered mostly from tiredness (81%), dry skin (63%), and shortness of breath (51%). Highest DORs (95% CI) were reported for tiredness (5.94 (3.70–9.60)), hair loss (4.58 (2.80–7.51)), and dry skin (4.09 (2.73–6.16)). A hypothyroidism-component-score was defined as the number of hypothyroidism-associated symptoms (range: 0–13). LR+ for participants with a hypothyroidism-component-score of 0 was 0.21 (0.09–0.39), meaning that the post-test probability was lowered to 21% of what it was before asking for symptoms. LR+ for scores of 1–2/3/4–6/7–9/10–13 were: 0.47 (0.30–0.72)/1.16 (0.70–1.87)/1.90 (1.29–2.45)/3.52 (2.30–5.36)/6.29 (2.30–17.7).ConclusionsNone of the individual symptoms of hypothyroidism had high LRs or DORs. Thus, neither the presence nor absence of any individual hypothyroidism symptom was reliable in the decision making of who should have their thyroid function tested. Therefore, even minor suspicion should lead to a blood test.

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Sentence Repetition: A Clinical Marker for Developmental Language Disorder in Danish

Journal of Speech Language and Hearing Research ◽

10.1044/2019_jslhr-l-18-0327 ◽

2019 ◽

Vol 62 (12) ◽

pp. 4450-4463

Author(s):

Rikke Vang Christensen

Keyword(s):

Language Disorder ◽

Future Research ◽

Typically Developing ◽

Developmental Language Disorder ◽

Older Children ◽

Likelihood Ratios ◽

Clinical Marker ◽

Sentence Repetition ◽

Good Identification ◽

Syntactic Properties

Purpose The aim of the study was to explore the potential of performance on a Danish sentence repetition (SR) task—including specific morphological and syntactic properties—to identify difficulties in children with developmental language disorder (DLD) relative to typically developing (TD) children. Furthermore, the potential of the task as a clinical marker for Danish DLD was explored. Method SR performance of children with DLD aged 5;10–14;1 (years;months; n = 27) and TD children aged 5;3–13;4 ( n = 87) was investigated. Results Compared to TD same-age peers, children with DLD were less likely to repeat the sentences accurately but more likely to make ungrammatical errors with respect to verb inflection and use of determiners and personal pronouns. Younger children with DLD also produced more word order errors that their TD peers. Furthermore, older children with DLD performed less accurately than younger TD peers, indicating that the SR task taps into morphosyntactic areas of particular difficulty for Danish children with DLD. The classification accuracy associated with SR performance showed high levels of sensitivity and specificity (> 90%) and likelihood ratios indicating good identification potential for clinical and future research purposes. Conclusion SR performance has a strong potential for identifying children with DLD, also in Danish, and with a carefully designed SR task, performance has potential for revealing morphosyntactic difficulties. Supplemental Material https://doi.org/10.23641/asha.10314437

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Clausal Density Between Ages 4 and 9 Years for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

Language Speech and Hearing Services in Schools ◽

10.1044/2020_lshss-20-00043 ◽

2020 ◽

pp. 1-15

Author(s):

Ling-Yu Guo ◽

Phyllis Schneider ◽

William Harrison

Keyword(s):

Diagnostic Accuracy ◽

Psychometric Properties ◽

Language Impairment ◽

Reference Data ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Criterion Validity ◽

Likelihood Ratios ◽

Generation Task ◽

Sensitivity Specificity

Purpose This study provided reference data and examined psychometric properties for clausal density (CD; i.e., number of clauses per utterance) in children between ages 4 and 9 years from the database of the Edmonton Narrative Norms Instrument (ENNI). Method Participants in the ENNI database included 300 children with typical language (TL) and 77 children with language impairment (LI) between the ages of 4;0 (years;months) and 9;11. Narrative samples were collected using a story generation task, in which children were asked to tell stories based on six picture sequences. CD was computed from the narrative samples. The split-half reliability, concurrent criterion validity, and diagnostic accuracy were evaluated for CD by age. Results CD scores increased significantly between ages 4 and 9 years in children with TL and those with LI. Children with TL produced higher CD scores than those with LI at each age level. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of CD scores were all significant at each age level, with the magnitude ranging from small to large. The diagnostic accuracy of CD scores, as revealed by sensitivity, specificity, and likelihood ratios, was poor. Conclusions The finding on diagnostic accuracy did not support the use of CD for identifying children with LI between ages 4 and 9 years. However, given the attested reliability and validity for CD, reference data of CD from the ENNI database can be used for evaluating children's difficulties with complex syntax and monitoring their change over time. Supplemental Material https://doi.org/10.23641/asha.13172129

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