Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens

2019 ◽  
Vol 152 (6) ◽  
pp. 742-746 ◽  
Author(s):  
Robyn C Reed ◽  
M Cristina Pacheco
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Mucosal Injury ◽  
Clinical Suspicion ◽  
Duodenal Biopsy ◽  
Biopsy Specimens ◽  
Active Inflammation ◽  
Intraepithelial Lymphocytosis

Abstract Objectives Disaccharidase (DS) activity in duodenal biopsy specimens is the gold standard for diagnosing DS deficiency. We investigated strategies to reduce the need for DS testing and whether clinical or histopathologic factors predict DS deficiency. Methods A retrospective chart review analyzed 1,678 DS results in children, biopsy indication(s), and duodenal histopathology. Results One or more DSs were abnormal in 42.8%. Sufficient lactase predicted sucrase, palatinase, and maltase sufficiency (negative predictive value 97.7%). Three patients had sucrase-isomaltase deficiency (0.2%). DS deficiency was more common in biopsy specimens for positive celiac serology (78.0%). Villous blunting, intraepithelial lymphocytosis, and active inflammation predicted DS deficiency; a combination of any two had an 81.4% positive predictive value. Conclusions Utilization could be reduced by only testing cases with normal duodenal histopathology and ongoing clinical suspicion for DS deficiency after reviewing pathology. In cases with suspected celiac disease and/or mucosal injury, DS deficiency is common and likely secondary, limiting test utility.

scholarly journals Development of an Electronic Algorithm to Identify Inappropriate Antibiotic Prescribing for Pediatric Pharyngitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s188-s189
Author(s):  
Jeffrey Gerber ◽  
Robert Grundmeier ◽  
Keith Hamilton ◽  
Lauri Hicks ◽  
Melinda Neuhauser ◽  
...  
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Antibiotic Stewardship ◽  
Chart Review ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Tract Infections ◽  
The Impact

Background: Antibiotic overuse contributes to antibiotic resistance and unnecessary adverse drug effects. Antibiotic stewardship interventions have primarily focused on acute-care settings. Most antibiotic use, however, occurs in outpatients with acute respiratory tract infections such as pharyngitis. The electronic health record (EHR) might provide an effective and efficient tool for outpatient antibiotic stewardship. We aimed to develop and validate an electronic algorithm to identify inappropriate antibiotic use for pediatric outpatients with pharyngitis. Methods: This study was conducted within the Children’s Hospital of Philadelphia (CHOP) Care Network, including 31 pediatric primary care practices and 3 urgent care centers with a shared EHR serving >250,000 children. We used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify encounters for pharyngitis at any CHOP practice from March 15, 2017, to March 14, 2018, excluding those with concurrent infections (eg, otitis media, sinusitis), immunocompromising conditions, or other comorbidities that might influence the need for antibiotics. We randomly selected 450 features for detailed chart abstraction assessing patient demographics as well as practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for evaluating the electronic algorithm. Criteria for appropriate use included streptococcal testing, use of penicillin or amoxicillin (absent β-lactam allergy), and a 10-day duration of therapy. Results: In 450 patients, the median age was 8.4 years (IQR, 5.5–9.0) and 54% were women. On chart review, 149 patients (33%) received an antibiotic, of whom 126 had a positive rapid strep result. Thus, based on chart review, 23 subjects (5%) diagnosed with pharyngitis received antibiotics inappropriately. Amoxicillin or penicillin was prescribed for 100 of the 126 children (79%) with a positive rapid strep test. Of the 126 children with a positive test, 114 (90%) received the correct antibiotic: amoxicillin, penicillin, or an appropriate alternative antibiotic due to b-lactam allergy. Duration of treatment was correct for all 126 children. Using the electronic algorithm, the proportion of inappropriate prescribing was 28 of 450 (6%). The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were sensitivity (99%, 422 of 427); specificity (100%, 23 of 23); positive predictive value (82%, 23 of 28); and negative predictive value (100%, 422 of 422). Conclusions: For children with pharyngitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. Future work should validate this approach in other settings and develop and evaluate the impact of an audit and feedback intervention based on this tool.Funding: NoneDisclosures: None

scholarly journals Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s32-s32
Author(s):  
Ebbing Lautenbach ◽  
Keith Hamilton ◽  
Robert Grundmeier ◽  
Melinda Neuhauser ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Predictive Value ◽  
Gold Standard ◽  
Chart Review ◽  
Acute Bronchitis ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Diagnostic Codes ◽  
Icd 10 ◽  
The Impact

Background: Antibiotic resistance has increased at alarming rates, driven predominantly by antibiotic overuse. Although most antibiotic use occurs in outpatients, antimicrobial stewardship programs have primarily focused on inpatient settings. A major challenge for outpatient stewardship is the lack of accurate and accessible electronic data to target interventions. We sought to develop and validate an electronic algorithm to identify inappropriate antibiotic use for outpatients with acute bronchitis. Methods: This study was conducted within the University of Pennsylvania Health System (UPHS). We used ICD-10 diagnostic codes to identify encounters for acute bronchitis at any outpatient UPHS practice between March 15, 2017, and March 14, 2018. Exclusion criteria included underlying immunocompromising condition, other comorbidity influencing the need for antibiotics (eg, emphysema), or ICD-10 code at the same visit for a concurrent infection (eg, sinusitis). We randomly selected 300 (150 from academic practices and 150 from nonacademic practices) eligible subjects for detailed chart abstraction that assessed patient demographics and practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for assessment of the electronic algorithm. Because antibiotic use is not indicated for this study population, appropriateness was assessed based upon whether an antibiotic was prescribed or not. Results: Of 300 subjects, median age was 61 years (interquartile range, 50–68), 62% were women, 74% were seen in internal medicine (vs family medicine) practices, and 75% were seen by a physician (vs an advanced practice provider). On chart review, 167 (56%) subjects received an antibiotic. Of these subjects, 1 had documented concern for pertussis and 4 had excluding conditions for which there were no ICD-10 codes. One received an antibiotic prescription for a planned dental procedure. Thus, based on chart review, 161 (54%) subjects received antibiotics inappropriately. Using the electronic algorithm based on diagnostic codes, underlying and concurrent conditions, and prescribing data, the number of subjects with inappropriate prescribing was 170 (56%) because 3 subjects had antibiotic prescribing not noted based on chart review. The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were the following: sensitivity, 100% (161 of 161); specificity, 94% (130 of 139); positive predictive value, 95% (161 of 170); and negative predictive value, 100% (130 of 130). Conclusions: For outpatients with acute bronchitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future studies.Funding: NoneDisclosures: None

Response to Intravenous Immunoglobulin Predicts Splenectomy Response in Children With Immune Thrombocytopenic Purpura

PEDIATRICS ◽  
2003 ◽  
Vol 111 (1) ◽  
pp. 87-90
Author(s):  
Derick Holt ◽  
Justin Brown ◽  
Kelly Terrill ◽  
Robert Goldsby ◽  
Rebecka L. Meyers ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Immune Thrombocytopenic Purpura ◽  
Predictive Value ◽  
Chart Review ◽  
Objective Response ◽  
Retrospective Chart Review ◽  
Poor Response ◽  
Thrombocytopenic Purpura ◽  
Excellent Response ◽  
Chronic Itp

Objective. Response to intravenous immunoglobulin (IVIG) has been shown to predict response to splenectomy in adults with immune thrombocytopenic purpura (ITP). However, reports in children have been inconsistent. We sought to determine whether response to IVIG is predictive of response to splenectomy in children. Methods. Thirty-two assessable children were identified by a retrospective chart review. Response was graded according to previously published criteria as follows: “excellent” (platelets >150 000 within 1 week), “good” (platelets between 50 000 and 150 000), and “poor” (platelets <50 000). “Response” refers to both splenectomy and IVIG, and response to splenectomy was counted only when it was durable. Results. Twenty-one of 23 patients who had a good or excellent response to IVIG also had an excellent response to splenectomy. Six of 9 patients who had a poor response to IVIG also had a poor response to splenectomy. Response to IVIG was a sensitive predictor of response to splenectomy in 88% of patients. Response to IVIG had a specificity of 75%, a positive predictive value of 91%, and a negative predictive value of 67%. Response to prednisone and length of time to splenectomy were not correlated with splenectomy response. Conclusions. These results suggest that response to IVIG is predictive of response to splenectomy in children with chronic ITP. This correlation may be of value in deciding whether a splenectomy should be performed in children with chronic ITP.

Frequency of Significant Prostate Cancer (Gleason Score ≥ 7) in Suspected Patients Having Pi-Rads Score ≥4: Descriptive Study

2021 ◽  
Vol 15 (10) ◽  
pp. 2625-2627
Author(s):  
Madiha Bangash ◽  
Sehrish Shamrez Khan ◽  
Mahjabeen Naimat ◽  
Sana Afzal Alvi ◽  
S Kanza Afzal ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Gleason Score ◽  
Predictive Value ◽  
Gold Standard ◽  
Armed Forces ◽  
Prostate Tumor ◽  
Mri Imaging ◽  
Cross Sectional ◽  
Biopsy Specimens

Background: Most common malignancy among males is prostate cancer causing many deaths. Aim: To determine the diagnostic accuracy of PI-RADS ≥4 lesions in predicting prostate tumor keeping histopathology as gold standard. Study Design: Cross-sectional validation. Methodology: The current project was conducted at Department of Radiology, Armed Forces Institute of Radiology and Imaging, Rawalpindi. Total 114 patients suspicion of prostate carcinoma between 40 to 80 years of age were included. Patients with already diagnosed carcinoma prostate and with inadequate biopsy specimens for diagnosing prostate cancer were excluded. After including the patients in this study, all patients were undergone MRI imaging findings to calculate PI-RADs score as per operational definition. After that biopsy specimens were taken and sent to the histopathology department for determination of Gleason score (GS), a patient was labelled as having significant prostate tumor. Results: Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of PI-RADS ≥4 lesions in predicting prostate tumor keeping histopathology as gold standard was 84.85%, 83.33%, 87.50%, 80% and 84.21% respectively. Conclusion: PI-RADS ≥4 is non-invasive modality of choice with high diagnostic accuracy in detecting ca prostate. Keywords: Prostate Cancer, Prostate Imaging Reporting and Sensitivity

Bupropion in the treatment of postural orthostatic tachycardia syndrome (POTS): a single-center experience

2020 ◽  
Vol 68 (6) ◽  
pp. 1156-1158
Author(s):  
Rohit Vyas ◽  
Zeid Nesheiwat ◽  
Mohammed Ruzieh ◽  
Zaid Ammari ◽  
Mohammad Al-Sarie ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Gold Standard ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Potential Treatment ◽  
Single Center ◽  
Single Center Experience ◽  
Dopamine Reuptake ◽  
Dopamine Reuptake Inhibitor

Postural orthostatic tachycardia syndrome (POTS) is estimated to impact millions of people each year. However, there is no established gold standard for its treatment. Bupropion is a norepinephrine and a dopamine reuptake inhibitor and has been implicated as a potential treatment for POTS. We performed a non-randomized retrospective chart review on 47 patients with POTS with statistical analysis evaluating for significant findings including reduced orthostasis and improvement of symptoms with the use of bupropion. Bupropion was not associated with a statistically significant improvement in orthostatic vitals but there was an overall reduction in reported syncope. While the use of bupropion does not show a statistically significant impact on orthostatic vitals in patients with POTS, it did show a degree of improvement in syncope and as such might be useful in patients with syncope-predominant POTS.

Development of a novel algorithm to identify staging and lines of therapy for bladder cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18235-e18235 ◽  
Author(s):  
Clint Cary ◽  
Anna Roberts ◽  
Abby K Church ◽  
George Eckert ◽  
Fangqian Ouyang ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Language Processing ◽  
Predictive Value ◽  
Gold Standard ◽  
Chart Review ◽  
Clinical Stage ◽  
Treatment Algorithm ◽  
Clinical Staging ◽  
Muscle Invasive ◽  
Sensitivity Specificity

e18235 Background: Large automated electronic medical record (EMR) databases have the potential to be valuable tools in studying the patterns and effectiveness of treatment. Therefore, the current study sought to develop novel tools to identify bladder cancer cases, their clinical stage, and the chemotherapy they receive in electronic medical records. Methods: EMR data were obtained from Indiana University Health hospitals from 2008 to 2015. We developed 2 novel algorithms using natural language processing on unstructured data to identify (a) bladder cancer cases and clinical stage, and (b) chemotherapy names and line of chemotherapy. Performance characteristics for each algorithm were assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Each algorithm’s performance for case ascertainment was measured against the gold standard of manual chart review. Results: A total of 2,559 unique bladder cancer patients were identified and stratified using the clinical staging algorithm, defined as metastatic, muscle invasive, or non-muscle invasive. We identified 657 metastatic cases, 567 muscle invasive cases, and 604 non-muscle invasive cases. Next, the treatment algorithm was applied to metastatic patients to identify the type of chemotherapy received and 1st or 2nd line of therapy. The sensitivity, specificity, PPV, and NPV for the clinical staging and treatment algorithm were calculated against the gold standard of manual chart review (Table). Conclusions: The performance of the staging algorithm demonstrates the strength of using innovative approaches. The poor performance of the treatment algorithm sets a framework from which to build upon in future work and suggests that structured approaches may still be the preferable approach. [Table: see text]

scholarly journals The Sensitivity and Specificity of Touch Preparation for Rapid Diagnosis of Invasive Fungal Sinusitis: A Pilot Study

2019 ◽  
Vol 100 (1) ◽  
pp. 55-59
Author(s):  
Theodore A. Schuman ◽  
Josephine H. Nguyen ◽  
Joshua C. Yelverton ◽  
Jorge A. Almenara ◽  
Celeste N. Powers
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Rapid Diagnosis ◽  
Fungal Sinusitis ◽  
Invasive Fungal Sinusitis ◽  
Touch Preparation ◽  
Pathologic Analysis ◽  
Initial Results

Invasive fungal sinusitis is a morbid pathology that typically affects immunocompromised patients and may quickly progress to fulminant disease. The purpose of this study was to measure the sensitivity and specificity of touch preparation of nasal debridement specimens as a rapid diagnostic tool for invasive fungal sinusitis. A retrospective chart review was performed of 22 patients undergoing nasal debridement due to suspicion for invasive fungal sinusitis over a 10-year period. Thirteen patients had touch preparation of nasal specimens followed by routine histologic processing; two of these patients underwent 2, and 1 patient had 3 separate debridements, for a total of 17 touch preparations performed. The sensitivity and specificity of touch preparation were calculated by correlating the initial results with the presence of fungal invasion on final pathologic analysis. The sensitivity of touch preparation was 56% (95% confidence interval [CI]: 0.23-0.85), specificity was 100% (95% CI: 0.60-1.00), positive predictive value was 100% (95% CI: 0.46-1.00), and negative predictive value was 67% (95% CI: 0.35-0.89). This procedure may be a useful adjunct in situations requiring rapid diagnosis of invasive fungal sinusitis but should not be used as the sole criteria for determining the need for surgical intervention.

scholarly journals External validation of 4C ISARIC mortality score in the setting of a Saudi Arabian ICU. Retrospective study

2021 ◽  
Author(s):  
Shahzad A. Mumtaz ◽  
Saima A. Shahzad ◽  
Intekhab Ahmed ◽  
Mohammed A. Alodat ◽  
Mohamed Gharba ◽  
...  
Keyword(s):  
Predictive Value ◽  
Chart Review ◽  
External Validation ◽  
Retrospective Chart Review ◽  
Saudi Arabian ◽  
Healthcare Systems ◽  
Mortality Prediction ◽  
Discriminatory Ability ◽  
Optimal Criterion ◽  
Medical City

AbstractCOVID-19 pandemic has burdened healthcare systems, necessitating the development of mortality prediction scores to guide clinical decisions and resource allocation. 4C ISARIC mortality score was developed and validated on a British cohort.ObjectivesExternal validation of the score in the setting of a large Saudi Arabian ICU.MethodRetrospective chart review of COVID-19 patients admitted to ICU of King Saud Medical City, Riyadh, Saudi Arabia. Collecting data to calculate the score, then fitting a ROC curve against known patients’ outcome.ResultsCohort included 1493 patients with 38% mortality, AUC of the score was 0.81 (95% CI: 0.79 – 0.83, p < 0.001), correctly classifying 72.67% of the cohort. Cut-off value of > 9 had sensitivity of 70.5% (95% CI: 66.6 – 74.3), specificity 73.97% (95% CI: 71 – 76.8), positive predictive value 62.4% (95% CI: 59.5 – 65.2), and negative predictive value 80.2% (95% CI: 78.2 – 82.4).Conclusion4C ISARIC mortality risk score performed well with a good discriminatory ability for critically ill patients admitted to ICU in our setting. Cut-off > 9 was the optimal criterion.

Flexion-Extension Cervical Spine Plain Films Compared with MRI in the Diagnosis of Ligamentous Injury

2010 ◽  
Vol 76 (6) ◽  
pp. 595-598 ◽  
Author(s):  
Therèse M. Duane ◽  
Justin Cross ◽  
Nicholas Scarcella ◽  
Luke G. Wolfe ◽  
Julie Mayglothling ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Glasgow Coma Scale ◽  
Predictive Value ◽  
Gold Standard ◽  
Injury Severity ◽  
Clinical Suspicion ◽  
Ligamentous Injury ◽  
High Clinical Suspicion ◽  
Plain Films ◽  
Flexion Extension

The purpose of this study was to compare flexion-extension (FE) plain films with MRI as the gold standard in the diagnosis of ligamentous injury (LI) of the cervical spine after trauma. A retrospective review of patients sustaining blunt trauma from January 2000 to December 2008 (n = 22929) who had both FE and MRI of the cervical spine was performed. Two hundred seventy-one patients had 303 FE films. Forty-nine also had MRI. The average Injury Severity Score was 15.6 ± 10.2, Glasgow Coma Scale was 13.8 ± 3.5, lactate 2.2 ± 1.7 mmol/L, and hospital stay of 8 ± 11.2 days. FE failed to identify all eight LIs seen on MRI. FE film sensitivity was 0 per cent (zero of eight), specificity 98 per cent (40 of 41), positive predictive value 0 per cent (zero of one), and negative predictive value 83 per cent (40 of 48). Although classified as negative for purposes of analysis, FE was incomplete 20.5 per cent (62 of 303) and ambiguous 9.2 per cent (28 of 303) of the time. The charge of FE is $535 so $48150 (90 incomplete/ambiguous films) could have been saved by eliminating these films. FE should no longer be used to diagnose LI. Given the rare incidence of these injuries, MRI should be used when there is high clinical suspicion of injury.

scholarly journals Tongue Blade Bite Test Predicts Mandible Fractures

2016 ◽  
Vol 9 (2) ◽  
pp. 121-124 ◽  
Author(s):  
John Neiner ◽  
Rachael Free ◽  
Gloria Caldito ◽  
Tara Moore-Medlin ◽  
Cherie-Ann Nathan
Keyword(s):  
Predictive Value ◽  
Chart Review ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
High Sensitivity ◽  
Ct Scans ◽  
Facial Trauma ◽  
Institutional Review ◽  
Mandible Fractures

The aim of the study is to evaluate the utility of a simple tongue blade bite test in predicting mandible fractures and use this test as an alternative screening tool for further workup. This is a retrospective chart review. An institutional review board approved the retrospective review of patients evaluated by the Department of Otolaryngology at a single institution for facial trauma performed from November 1, 2011, to February 27, 2014. Patients who had a bite test documented were included in the study. CT was performed in all cases and was used as the gold standard to diagnose mandible fractures. Variables analyzed included age, sex, fracture type/location on CT, bite test positivity, and operative intervention. A total of 86 patients met the inclusion criteria and of those 12 were pediatric patients. Majority of the patients were male (80.2%) and adult (86.0%; average age: 34.3 years). Fifty-seven patients had a negative bite test and on CT scans had no mandible fracture. Twenty-three patients had a positive bite test and a CT scan confirmed fracture. The bite test revealed a sensitivity of 88.5% (95% CI: 69.8–97.6%), specificity of 95.0% (95% CI:86.1–99%), positive predictive value [PPV] of 88.5% (95% CI: 69.8–97.6%), and negative predictive value [NPV] of 95.0% (95% CI: 86.1–99.0%). Among pediatric patients, the sensitivity was 100% (95% CI: 29.9–100%), specificity was 88.9% (95% CI: 68.4–100%), PPV was 75.0% (95% CI: 19.4–99.4%), and NPV was 100% (95% CI: 63.1–100%). The tongue blade bite test is a quick inexpensive diagnostic tool for the otolaryngologist with high sensitivity and specificity for predicting mandible fractures. In the pediatric population, where avoidance of unnecessary CT scans is of highest priority, a wider range of data collection should be undertaken to better assess its utility.

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