Validation of Statewide Surveillance System Data on Central Line–Associated Bloodstream Infection in Intensive Care Units in Australia

Objective.To measure the interobserver agreement, sensitivity, specificity, positive predictive value, and negative predictive value of data submitted to a statewide surveillance system for identifying central line-associated bloodstream infection (BSI).Design.Retrospective review of hospital medical records comparing reported data with gold standard according to definitions of central line–associated BSI.Setting.Six Victorian public hospitals with more than 100 beds.Methods.Reporting of surveillance outcomes was undertaken by infection control practitioners at the hospital sites. Retrospective evaluation of the surveillance process was carried out by independent infection control practitioners from the Victorian Hospital Acquired Infection Surveillance System (VICNISS). A sample of records of patients reported to have a central line-associated BSI were assessed to determine whether they met the definition of central line–associated BSI. A sample of records of patients with bacteremia in the intensive care unit during the assessment period who were not reported as having central line–associated BSI were also assessed to see whether they met the definition of central line-associated BSI.Results.Records of 108 patients were reviewed; the agreement between surveillance reports and the VICNISS assessment was 67.6% (κ = 0.31). Of the 46 reported central line–associated BSIs, 27 were confirmed to be central line–associated BSIs, for a positive predictive value of 59% (95% confidence interval [CI], 43%–73%). Of the 62 cases of bacteremia reviewed that were not reported as central line–associated BSIs, 45 were not associated with a central line, for a negative predictive value of 73% (95% CI, 60%–83%). Estimated sensitivity was 35%, and specificity was 87%. The positive likelihood ratio was 3.0, and the negative likelihood ratio was 0.72.Discussion.The agreement between the reporting of central line–associated BSI and the gold standard application of definitions was unacceptably low. False-negative results were problematic; more than half of central line–associated BSIs may be missed in Victorian public hospitals.

Download Full-text

Agreement in the diagnosis of dental fluorosis in central incisors performed by a standardized photographic method and clinical examination

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2009000500008 ◽

2009 ◽

Vol 25 (5) ◽

pp. 1017-1024 ◽

Cited By ~ 11

Author(s):

Carolina Castro Martins ◽

Loliza Chalub ◽

Ynara Bosco Lima-Arsati ◽

Isabela Almeida Pordeus ◽

Saul Martins Paiva

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Clinical Examination ◽

Predictive Value ◽

Gold Standard ◽

Dental Fluorosis ◽

Digital Camera ◽

High Specificity ◽

Photographic Method ◽

Pediatric Dentists

The aim of this study was to assess agreement in the diagnosis of dental fluorosis performed by a standardized digital photographic method and a clinical examination (gold standard). 49 children (aged 7-9 years) were clinically evaluated by a trained examiner for the assessment of dental fluorosis. Central incisors were evaluated for the presence or absence of dental fluorosis and were photographed with a digital camera. Photographs were presented to three pediatric dentists, who examined the images. Data were analyzed using Cohen's kappa and validity values. Agreement in the diagnosis performed by the photographic method and clinical examination was good (0.67) and accuracy was 83.7%. The prevalence of dental fluorosis was reported to be higher in the clinical examination (49%) compared with the photographic method (36.7%). The photographic method presented higher specificity (96%) than sensitivity (70.8%), a positive predictive value (PPV) of 94.4% and a negative predictive value (NPV) of 77.4%. The diagnosis of dental fluorosis performed using the photographic method presented high specificity and PPV, which indicates that the method is reproducible and reliable for recording dental fluorosis.

Download Full-text

Correlation of clinical examination, ultrasound, magnetic resonance imaging and arthroscopy as diagnostic tools in shoulder pathology

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200473 ◽

2020 ◽

Vol 6 (2) ◽

pp. 247

Author(s):

Sondipon Biswas ◽

Naman Kanodia ◽

Rajat Tak ◽

Siddharth Agrawal ◽

Kiran Shankar Roy

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Gold Standard ◽

Shoulder Arthroscopy ◽

Resonance Imaging ◽

Shoulder Pathologies

Background: Shoulder pathologies can cause significant pain, discomfort, and affect the activity of daily living. The aim of this study was to compare the efficacy of clinical examination, ultrasound, magnetic resonance imaging (MRI) with shoulder arthroscopy in diagnosing various shoulder pathologies, considering shoulder arthroscopy as the gold standard tool.Methods: This was a prospective, comparative study conducted over 35 patients, between 18-75 years of age presenting with chronic shoulder pain or instability of more than 2 months duration. All patients were examined clinically, followed by high resolution ultrasound, MRI, arthroscopy of the affected shoulder.Results: The sensitivity and specificity of ultrasonography (USG) for diagnosing full thickness tear was 100% each and for MRI was 88% and 100% respectively. For subacromial impingement USG had sensitivity of 66.67%, specificity of 94.12%, positive predictive value of 50% and negative predictive value of 88.89%. For rotator cuff tear USG had sensitivity of 92.86%, specificity of 50%, positive predictive value of 81.25% and negative predictive value of 75% considering shoulder arthroscopy as gold standard.Conclusions: USG and MRI both are sensitive techniques for diagnosing of rotator cuff pathologies. USG has high accuracy in diagnosing partial thickness tears as compare to MRI. MRI proved to be superior in estimation of site and extent of tear. Considering shoulder arthroscopy as gold standard, it can be reserved for patients with suspicious of USG/MRI findings or those who may need surgical intervention simultaneously.

Download Full-text

Comparison of International Federation of cervical pathology and colposcopy nomenclature (2011) and Swede score for assessment of cervical lesions

10.21203/rs.3.rs-169936/v1 ◽

2021 ◽

Author(s):

Bindiya Gupta ◽

Rashmi Shreya ◽

Shalini Rajaram ◽

Anshuja Singla ◽

Sandhya Jain ◽

...

Keyword(s):

Positive Predictive Value ◽

Prospective Study ◽

Negative Predictive Value ◽

Predictive Value ◽

Gold Standard ◽

International Federation ◽

Objective Method ◽

Cervical Lesions ◽

Sensitivity Specificity ◽

Strength Of Association

Abstract Purpose: Standardization of colposcopic evaluation is important as it is observer dependent.The aim of the study was to compare the strength of association of colposcopic findings by International Federation of Colposcopy and Cervical Pathology (IFCPC) nomenclature and Swede score. Methods: In the prospective study, 150 women aged 30 to 60 years with abnormal screening results underwent colposcopy, the findings were evaluated using both IFCPC and Swede score and biopsy was taken from abnormal areas. Performances by both the methods were calculated taking biopsy as gold standard. Results: Nineteen ≥ CIN2 lesions were detected. The sensitivity, specificity, positive predictive value and negative predictive value for detecting ≥ CIN2 lesion by IFCPC scoring was 63.6%, 96.0%, 78.7%, 91.9%. Using Swede score, sensitivity, specificity, positive predictive value and negative predictive value at cut off of 8 were 42.4, 95%, 96.6% and 81.8% while at cut-off of 5, these were 96%, 88.3%,76.7% and 93.6%. The agreement between IFCPC major lesion and Swede score ≥ 8 for ≥ CIN2 was 0.626 (p<0.01). Conclusion: Swede score is an easier and more objective method for colposcopic evaluation and a score >8 can be applied to the screen and treat programme.

Download Full-text

DIAGNOSTIC ACCURACY OF ULTRASOUND IN THE DETECTION OF PNEUMOTHORAX IN CHEST TRAUMA PATIENTS WITH CT AS THE GOLD STANDARD

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i7.2022 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

Danquale Vance Kynshikhar ◽

Chaman Lal Kaushal ◽

Ashwani Tomar ◽

Neeti Aggarwal

Keyword(s):

Emergency Department ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Gold Standard ◽

Chest Trauma ◽

Accurate Diagnosis ◽

Trauma Patients ◽

Chest Ultrasound

Background: To study the diagnostic accuracy of ultrasound in the detection of pneumothorax in chest trauma patients with CT as the Gold Standard Methods: The present study was conducted from 31th July 2018 to 30th July 2019. A total of 36 patients were enrolled in the study. Results: By chest ultrasound, pneumothorax was detected in 15 of 24 patients. The sensitivity of chest ultrasound for the diagnosis of pneumothorax was 62.5%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 54.14% and accuracy was 75%. Conclusion: Chest ultrasound can play an important role in the emergency department aiding a physician for bedside rapid and accurate diagnosis of pneumothorax without interruption in the resuscitation process and without transferring the patient to the radiology section. Keywords: Ultrasound, CT, Pneumothorax

Download Full-text

Clinical predictors of hypoxemia in 1-5 year old children with pneumonia

Paediatrica Indonesiana ◽

10.14238/pi50.6.2010.355-60 ◽

2016 ◽

Vol 50 (6) ◽

pp. 355

Author(s):

Made Supartha ◽

Putu Siadi Purniti ◽

Roni Naning ◽

Ida Bagus Subanada

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Clinical Manifestation ◽

Predictive Value ◽

Gold Standard ◽

Sampling Method ◽

Blood Analysis ◽

Clinical Predictors ◽

Arterial Blood ◽

Head Nodding

Background Pneumonia remains a major killer of under five children. Hypoxemia is the most serious manifestation of pneumonia. The most reliable way to detect hypoxemia is an arterial blood analysis or SPar However, these tools are not widely available; therefore, a simple clinical manifestation should be used as an alternative.Objective To determine clinical predictors of hypoxemia in 1-5 year-old children with pneumonia in Indonesia.Methods This study was conducted between February 2007 to August 2008 at Sanglah Hospital, Denpasar, Bali. Sample was selected using a convenient sampling method. Subjects were divided into group of hypoxemia and nonnal saturation. We did clinical examination and SpOz measurement, as the gold standard, simultaneously.Results From 120 subjects" the prevalence of hypoxemia was 17.5%. The best single clinical predictors of hypoxemia was cyanosis (sensitivity 43%, specificity 99%, positive predictive value (PPV) 90%, negative predictive value (NPV) 89%). The best combination of clinical predictors of hypoxemia was cyanosis and head nodding (sensitivity 43%, specificity 99%, PPV 90%, NPV 89%.Conclusion Cyanosis or combination of cyanosis and head nodding is useful clinical predictors of hypoxemia in childhood pneumonia.

Download Full-text

ROLE OF MRI IN DIAGNOSIS OF ROTATOR CUFF TEAR ASSUMING ARTHROSCOPY AS GOLD STANDARD

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i9.550 ◽

2019 ◽

Vol 3 (9) ◽

Author(s):

Dr. Chaturbhuj Prasad Swarnkar ◽

Dr. Shiv Raj Meena

Keyword(s):

Rotator Cuff ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Shoulder Pain ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Gold Standard ◽

Shoulder Joint ◽

Rotator Cuff Tears ◽

Arthroscopic Findings

Background- Rotator cuff tears are one of the most common causes of shoulder pain for which patients seek treatment. As in our daily work, the shoulder joint is the most frequently used, there is higher chance of having shoulder joint injury. The aim of the study is to compare the efficacy of MRI in diagnosing shoulder pathologies in comparison to arthroscopy, considering arthroscopy as the gold standard. Methods- 30 Patient with suspected rotator cuff injury patients, between 18-80 years of age was included in the study. MRI of the shoulder joint was done followed by shoulder arthroscopy. The data collected was analysed for the significant correlation between MRI of shoulder and arthroscopic findings by kappa statistics. Results- The accuracy of MRI in diagnosis of rotator cuff partial tears, was 90%, while sensitivity and specificity was 100.00%, 78.57% and positive predictive value was 84.21% and negative predictive value was 100.00% and accuracy of MRI in diagnosis of rotator cuff full tears, was 86.67%, while sensitivity and specificity was 63.64%, 100.00%) and positive predictive value was 100.00% and negative predictive value was 82.61% in our study. Conclusion- Our study demonstrates a high sensitivity and specificity for the MRI diagnosis of both partial and full thickness rotator cuff tears and good correlation with arthroscopic findings. Keywords: Rotator cuff, Shoulder pain, Arthroscopy, MRI.

Download Full-text

A Comparison between the Diagnostic Accuracy of Alvarado and Tzanaki Scoring Systems in Acute Appendicitis

10.53350/pjmhs2115123175 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3175-3177

Author(s):

Anum Iftikhar ◽

Muhammad Arsalan ◽

Sheeza Azaz ◽

S H Waqar ◽

Sajid Ali Shah ◽

...

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Gold Standard ◽

Scoring Systems ◽

Negative Appendectomy ◽

Alvarado Score ◽

Cross Sectional

Aim: To find out how accurate the Alvarado and Tzanaki scoring systems are in diagnosing acute appendicitis taking histopathology as gold standard. Methods: A cross-sectional prospective study was conducted from August 2019 to July 2020 at Department of General Surgery, Pakistan Institute of Medical Sciences Islamabad. Sixty patients were included, all of whom had appendectomies after a clinical diagnosis of acute appendicitis. Samples were submitted for histopathology, which was used as the gold standard for the definitive diagnosis of acute appendicitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and negative appendectomy rate of Alvarado and Tzanaki scoring systems was calculated using SPSS version 23. Results: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Alvarado score at optimal cut-off threshold of ≥7.0, were calculated as 74%, 55%, 90%, 27% and 71.66% respectively. The cut-off threshold point of Tzanaki score was set at more than 8, which yielded a 94.11% sensitivity and an 88.88% specificity. The positive predictive value was 99.95% and the negative predictive value was 72.72%. The Alvarado and Tzanaki scoring systems had negative appendectomy rates of 9.5% and 2.04%, respectively. Conclusion: The Tzanaki scoring system has a better diagnostic accuracy for acute appendicitis as compared to the Alvarado score. Keywords: Acute appendicitis, Alvarado score, Tzanaki score

Download Full-text

Clinical validation of the self-reported Glasgow Antipsychotic Side-effect Scale using the clinician-rated UKU side-effect scale as gold standard reference

Journal of Psychopharmacology ◽

10.1177/0269881120916122 ◽

2020 ◽

Vol 34 (8) ◽

pp. 820-828

Author(s):

Marlene Schouby Bock ◽

Oona Nørgaard Van Achter ◽

David Dines ◽

Maria Simonsen Speed ◽

Christoph U Correll ◽

...

Keyword(s):

Side Effects ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Gold Standard ◽

Side Effect ◽

Self Report ◽

Measurement Based Care ◽

Gold Standard Reference ◽

Antipsychotic Side Effects

Background: Antipsychotics are key for the treatment of psychotic and several non-psychotic disorders. Unfortunately, antipsychotic medications are associated with side effects, which may reduce quality of life and treatment adherence. Therefore, regular screening of antipsychotic side effects is essential. The Glasgow Antipsychotic Side-effect Scale is a patient self-report scale developed for this purpose. However, the Glasgow Antipsychotic Side-effect Scale has only been validated against another self-report side effect measure, which is suboptimal. Objective: We aimed to validate the Glasgow Antipsychotic Side-effect Scale using the clinician-rated Udvalg for Kliniske Undersøgelser side-effect rating scale as the gold standard reference. Results: 81 antipsychotic-treated outpatients with schizophrenia-spectrum disorders (age = 42±13 years; males = 43%, schizophrenia = 77%, illness duration: median = 11 years) completed the Glasgow Antipsychotic Side-effect Scale and were subsequently scored on the Udvalg for Kliniske Undersøgelser by trained raters. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for paired Glasgow Antipsychotic Side-effect Scale and Udvalg for Kliniske Undersøgelser items. Sensitivity of Glasgow Antipsychotic Side-effect Scale items ranged from 33–96%, with 19 (86%) having >75% sensitivity. Lowest sensitivity emerged for “nocturnal enuresis” (33%), “galactorrhea” (50%) and “hyperkinesia” 14–99%, with 14 items (64%) having >75% specificity, being lowest for “asthenia” (14%), “polyuria/polydipsia” (35%), “sedation” (41%), “akathisia” (53%), “dystonia” (65%), “hyperkinesia” (68%), “hypokinesia” (70%) and “accommodation” (70%). Positive predictive value ranged from 7–85%, with six items (27%) having a positive predictive value >75%. Negative predictive value ranged from 40–98%, with 21 items (95%) having a negative predictive value >75%. The mean time to complete the Glasgow Antipsychotic Side-effect Scale was 4±2 minutes. Conclusion: The Glasgow Antipsychotic Side-effect Scale demonstrated satisfactory validity as a self-rated tool for antipsychotic side effects and may aid measurement-based care and decision-making.

Download Full-text

Computed tomography versus ureteroscopy in identification of renal tract stone with ureteral stent in situ

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x13165261993996 ◽

2011 ◽

Vol 93 (8) ◽

pp. 639-641 ◽

Cited By ~ 4

Author(s):

VCY Tang ◽

A Attwell-Heap

Keyword(s):

Computed Tomography ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Gold Standard ◽

Ureteral Stent ◽

The Difference ◽

Contrast Ct ◽

Sensitivity Specificity

INTRODUCTION The aim of this study was to validate the use of non-contrast computed tomography (CT) with a ureteral stent in situ instead of ureteroscopy for identification of renal tract stones. METHODS All patients who had stents inserted for renal tract stones and underwent non-contrast CT with the stent in situ followed by ureteroscopy between May 2008 and October 2009 at The Canberra Hospital, Australia, were analysed retrospectively. Statistical analysis was performed to compare any differences between CT and ureteroscopy in the identification of stones. RESULTS Overall, 57 patients were included in the study. The difference between CT and ureteroscopy findings was statistically significant. CT identification of stones with a stent in situ had a sensitivity of 86%, a specificity of 46%, a positive predictive value of 63%, a negative predictive value of 76% and an accuracy of 67%. CONCLUSIONS Our study suggests that non-contrast CT is inferior to the ‘gold standard’ of ureteroscopy. It lacks sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Therefore, we cannot recommend using non-contrast CT to replace ureteroscopy.

Download Full-text

Relationship between Clinical, MRI, and Arthroscopic Findings: A Guide to Correct Diagnosis of Meniscal Tears

Joints ◽

10.1055/s-0037-1605583 ◽

2017 ◽

Vol 05 (03) ◽

pp. 164-167

Author(s):

P. Antinolfi ◽

R. Cristiani ◽

F. Manfreda ◽

S. Bruè ◽

V. Sarakatsianos ◽

...

Keyword(s):

Positive Predictive Value ◽

Prospective Study ◽

Negative Predictive Value ◽

Clinical Examination ◽

Predictive Value ◽

Gold Standard ◽

Careful Examination ◽

Meniscal Tears ◽

Arthroscopic Findings ◽

Clinical Mri

Purpose The aim of this prospective study was to compare and correlate clinical, MRI, and arthroscopic findings in cases of suspected meniscal tears. Using arthroscopic findings as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of clinical investigation and MRI were evaluated to determine if is possible, after a careful examination, to bypass MRI and perform directly arthroscopy in suspected cases. Methods A total of 80 patients with a history of knee trauma, preoperative RX, and MRI underwent arthroscopy over an 8-month period at our department. All patients had a clinical examination performed by an experienced knee surgeon. These examiners evaluated and recorded the results of three tests: medial and lateral joint line tenderness test, McMurray's test, and Apley's test. The injury was classified as a meniscal tear if there were at least two positive tests. Finally, using the arthroscopic findings as the gold standard, sensibility, specificity, accuracy, positive and negative predictive values of clinical examination, and MRI were evaluated and compared. Results Clinical examination performed by an experienced knee surgeon reported better sensitivity (91 vs. 85%), specificity (87 vs. 75%), accuracy (90 vs. 82%), positive predictive value (94 vs. 88%), and negative predictive value (81 vs. 71%) than MRI for medial meniscal tears. These parameters showed minimal differences for lateral meniscal tears. Conclusion Clinical examination performed by an experienced knee surgeon provided equal or better results to diagnose meniscal injuries in comparison to MRI. MRI is not necessary to confirm these lesions and should not be used as the primary diagnostic tool. Level of Evidence Level II, prospective study.

Download Full-text