scholarly journals P82 NUn score validation at a district general hospital

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Jacob Rapier ◽  
Steven Hornby ◽  
Jacob Rapier
Keyword(s):  
Positive Predictive Value ◽  
Anastomotic Leak ◽  
Confidence Intervals ◽  
Predictive Value ◽  
External Validation ◽  
District General Hospital ◽  
Anastomotic Leaks ◽  
Upper Gi ◽  
Increased Risk ◽  
Operative Complications

Abstract Introduction The NUn score was created to try and predict the risk of anastomotic leak or major complications (using the Clavien- Dindo classification) from upper GI resections with an oesophageal anastomosis. A score of > 10 was used to predict an increased risk. In this study we attempt validation. Methods A database of 101 patients was studied, who underwent an Oesophagectomy for cancer between March 2017 and 2020. 72 patients had complete Post-operative day 4 bloods, needed to calculate the score. These patients were then studied for post-operative complications. Results A total of 12 patients had a NUn score of > 10 (16.67%). There was 1 death (1.37%) and 11 anastomotic leaks (15.28%). Of these the NUn score did not predict the death and predicted 8 of the 11 anastomotic leaks. From our data Conclusion From our analysis the NUNs score cannot be shown to be sensitive, specific or have useful positive predictive value. The average Nun score was not reliable, with confidence intervals crossing 10. There may be some merit in using the test for its negative predictive value, but further analysis into this is needed. The results of this audit are consistent with previous efforts at external validation.

scholarly journals Agreement between commercially available ELISA and in-house Luminex SARS-CoV-2 antibody immunoassays

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rebeca Santano ◽  
Diana Barrios ◽  
Fàtima Crispi ◽  
Francesca Crovetto ◽  
Marta Vidal ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Diagnostic Tests ◽  
Distress Syndrome ◽  
Clinical Performance ◽  
External Validation ◽  
Severe Respiratory Distress ◽  
Technical Performance ◽  
Severe Respiratory Distress Syndrome

AbstractSerological diagnostic of the severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) is a valuable tool for the determination of immunity and surveillance of exposure to the virus. In the context of an ongoing pandemic, it is essential to externally validate widely used tests to assure correct diagnostics and epidemiological estimations. We evaluated the performance of the COVID-19 ELISA IgG and the COVID-19 ELISA IgM/A (Vircell, S.L.) against a highly specific and sensitive in-house Luminex immunoassay in a set of samples from pregnant women and cord blood. The agreement between both assays was moderate to high for IgG but low for IgM/A. Considering seropositivity by either IgG and/or IgM/A, the technical performance of the ELISA was highly imbalanced, with 96% sensitivity at the expense of 22% specificity. As for the clinical performance, the negative predictive value reached 87% while the positive predictive value was 51%. Our results stress the need for highly specific and sensitive assays and external validation of diagnostic tests with different sets of samples to avoid the clinical, epidemiological and personal disturbances derived from serological misdiagnosis.

scholarly journals Development and utilization of an intelligent application for aiding COVID-19 diagnosis

2020 ◽  
Author(s):  
Zirui Meng ◽  
Minjin Wang ◽  
Huan Song ◽  
Shuo Guo ◽  
Yanbing Zhou ◽  
...  
Keyword(s):  
Machine Learning ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Model Prediction ◽  
Predictive Value ◽  
External Validation ◽  
Prediction Performance ◽  
Development And Utilization ◽  
Laboratory Examinations ◽  
Diagnosis Model

ABSTRACTBackgroundCOVID-19 has been spreading globally since emergence, but the diagnostic resources are relatively insufficient.ResultsIn order to effectively relieve the resource deficiency of diagnosing COVID-19, we developed a machine learning-based diagnosis model on basis of laboratory examinations indicators from a total of 620 samples, and subsequently implemented it as a COVID-19 diagnosis aid APP to facilitate promotion.ConclusionsExternal validation showed satisfiable model prediction performance (i.e., the positive predictive value and negative predictive value was 86.35% and 84.62%, respectively), which guarantees the promising use of this tool for extensive screening.

scholarly journals Validation of claims-based algorithms for pulmonary arterial hypertension

2018 ◽  
Vol 8 (2) ◽  
pp. 204589401875924 ◽  
Author(s):  
Ravikanth Papani ◽  
Gulshan Sharma ◽  
Amitesh Agarwal ◽  
Sean J. Callahan ◽  
Winston J. Chan ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Positive Predictive Value ◽  
Arterial Hypertension ◽  
Predictive Value ◽  
External Validation ◽  
Administrative Claims ◽  
Predictive Values ◽  
C Statistic ◽  
Pulmonary Arterial ◽  
The University

Administrative claims studies do not adequately distinguish pulmonary arterial hypertension (PAH) from other forms of pulmonary hypertension (PH). Our aim is to develop and validate a set of algorithms using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and electronic medical records (EMR), to identify patients with PAH. From January 2012 to August 2015, the EMRs of patients with ICD-9-CM codes for PH with an outpatient visit at the University of Texas Medical Branch were reviewed. Patients were divided into PAH or non-PAH groups according to EMR encounter diagnosis. Patient demographics, echocardiography, right heart catheterization (RHC) results, and PAH-specific therapies were assessed. RHC measurements were reviewed to categorize cases as hemodynamically determined PAH or not PAH. Weighted sensitivity, specificity, and positive and negative predictive values were calculated for the developed algorithms. A logistic regression analysis was conducted to determine how well the algorithms performed. External validation was performed at the University of Virginia Health System. The cohort for the development algorithms consisted of 683 patients with PH, PAH group (n = 191) and non-PAH group (n = 492). A hemodynamic diagnosis of PAH determined by RHC was recorded in the PAH (26%) and non-PAH (3%) groups. The positive predictive value for the algorithm that included ICD-9-CM and PAH-specific medications was 66.9% and sensitivity was 28.2% with a c-statistic of 0.66. The positive predictive value for the EMR-based algorithm that included ICD-9-CM, EMR encounter diagnosis, echocardiography, RHC, and PAH-specific medication was 69.4% and a c-statistic of 0.87. A validation cohort of 177 patients with PH examined from August 2015 to August 2016 using EMR-based algorithms yielded a similar positive predictive value of 62.5%. In conclusion, claims-based algorithms that included ICD-9-CM codes, EMR encounter diagnosis, echocardiography, RHC, and PAH-specific medications better-identified patients with PAH than ICD-9-CM codes alone.

scholarly journals Guidelines for diagnosis and monitoring of thyroid disease: nonthyroidal illness

1996 ◽  
Vol 42 (1) ◽  
pp. 188-192 ◽  
Author(s):  
J R Stockigt
Keyword(s):  
Positive Predictive Value ◽  
Clinical Features ◽  
Thyroid Function ◽  
Predictive Value ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Reference Intervals ◽  
Free T4 ◽  
Prognostic Information ◽  
Increased Risk

Abstract On the basis of low specificity, poor positive predictive value, and cost, there is at present no basis for routine assessment of thyroid function in acutely hospitalized patients, unless clinical features suggest the possibility of thyroid dysfunction, or a patient's background increases the likelihood of thyroid dysfunction. When used in severely ill patients, estimates of both thyroxine (T4) and thyrotropin (TSH) show a high prevalence of abnormal results, but lack specificity and have poor positive predictive value for true thyroid disease. When thyroid function is tested in the critically ill, the positive predictive value for true thyroid disease of both free T4 and TSH measurements could be improved by using wider reference intervals than for unselected populations. The knowledge of nonspecific disease-related abnormalities of triiodothyronine, T4, and TSH is not currently likely to yield useful prognostic information or to alter management for individual patients. Thyroid testing should be readily available for any acutely ill patient with any clinical features that suggest thyroid dysfunction, and for groups at increased risk of thyroid dysfunction. An initial abnormal result for either TSH or free T4 estimate should be followed by combined analysis of free T4 and TSH with the best available methodology. Diagnosis of thyroid dysfunction should be based on the T4-TSH relation rather than either value alone. Persistence of an apparent diagnostic abnormality should be confirmed before therapy is commenced.

Discordance in Nuchal Translucency Measurements in Monochorionic Diamniotic Twins as Predictor of Twin-to-Twin Transfusion Syndrome

2009 ◽  
Vol 12 (6) ◽  
pp. 605-610 ◽  
Author(s):  
Ingeborg H. Linskens ◽  
Yolanda M. de Mooij ◽  
Jos W. Twisk ◽  
Willem J. Kist ◽  
Dick Oepkes ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Study Design ◽  
Predictive Value ◽  
Subsequent Development ◽  
Nuchal Translucency ◽  
Absolute Difference ◽  
Crown Rump Length ◽  
Increased Risk ◽  
Twin Pregnancies

AbstractObjective:Discordance in nuchal translucency measurements in monochorionic diamniotic twin pregnancies was assessed as predictor of Twin-to-Twin Transfusion Syndrome.Study Design:A total of 61 monochorionic diamniotic twins were enrolled. Nuchal translucency (NT) and crown-rump-length (CRL) discordance was calculated as the percentage of delta NT and CRL (absolute difference NT/CRL fetus 1 and fetus 2) of the largest measurement, and correlated with subsequent development of Twin-to-Twin Transfusion Syndrome.Results:Twin-to-Twin Transfusion Syndrome developed in 14/61 (23%) of cases. A NT discordance of 20% or more best predicted Twin-to-Twin Transfusion Syndrome development, with a sensitivity of 64% and a specificity of 78%. We found a positive predictive value of 50% and negative predicted value of 86% for Twin-to-Twin Transfusion Syndrome development if NT discordance was 20% or more.Conclusion:NT discordance of more than 20% in monochorionic diamniotic twins is associated with an increased risk for subsequent development of Twin-to-Twin Transfusion Syndrome, and with earlier presentation of symptoms.

scholarly journals Agreement between commercially available ELISA and in-house Luminex SARS-CoV-2 antibody immunoassays

2021 ◽  
Author(s):  
Rebeca Santano ◽  
Diana Barrios ◽  
Fàtima Crispi ◽  
Francesca Crovetto ◽  
Marta Vidal ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Diagnostic Tests ◽  
Distress Syndrome ◽  
Clinical Performance ◽  
External Validation ◽  
Severe Respiratory Distress ◽  
Technical Performance ◽  
Severe Respiratory Distress Syndrome

AbstractSerological diagnostic of the severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) is a valuable tool for the determination of immunity and surveillance of exposure to the virus. In the context of an ongoing pandemic, it is essential to externally validate widely used tests to assure correct diagnostics and epidemiological estimations. We evaluated the performance of the COVID-19 ELISA IgG and IgM/A (Vircell, S.L.) against a highly specific and sensitive in-house Luminex immunoassay in a set of samples from pregnant women and cord blood. The agreement between both assays was moderate to high for IgG but low for IgM/A. Considering seropositivity by either IgG and/or IgM/A, the technical performance of the ELISA was highly imbalanced, with 96% sensitivity at the expense of 22% specificity. As for the clinical performance, the negative predictive value reached 87% while the positive predictive value was 51%. Our results stress the need for highly specific and sensitive assays and external validation of diagnostic tests with different sets of samples to avoid the clinical, epidemiological and personal disturbances derived from serological misdiagnosis.

scholarly journals Identifying language disorder in bilingual children is possible only if both languages are assessed

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Nayeb ◽  
A Sarkadi ◽  
M Eriksson ◽  
E K Salameh ◽  
D Lagerberg
Keyword(s):  
Child Health ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Language Disorder ◽  
Mother Tongue ◽  
Bilingual Children ◽  
Predictive Values ◽  
Increased Risk ◽  
Child Healthcare ◽  
Language Screening

Abstract Background The number of bilingual people increases worldwide. In Sweden, one-third of all preschool age children are bilingual. Previous studies reported that bilingual children are at risk of being overlooked for early identification of language difficulties. There is a need of validated assessment instruments for identification of language disorder in bilingual children. Aim To investigate whether the language screening for three-year-olds used in Swedish Child healthcare would detect developmental language disorder (DLD) in bilingual children 6 month earlier. Methods Overall, 111 bilingual children (51% girls), 29-33 months, were screened from November 2015 to June 2017. They were recruited from three child health centres serving areas of low socio-economic status in Gävle, Sweden. The children were screened both in their mother tongue and in Swedish at the child health centre and consecutively assessed for DLD by a speech and language pathologist, blinded to the screening outcomes. Results Preliminary results from combining screening in Swedish and the child's mother tongue showed good accuracy: 88% sensitivity, 82% specificity, 67% positive and 94% negative predictive values. DLD was confirmed in 32 children (29%), of which 87.5% had screened positive and 12.5% negative. Specificity and positive predictive value increased radically when both languages were assessed, whereas sensitivity was less affected. A majority of the children who did not cooperate in the screening turned out to have DLD. Conclusions A language screening should be performed in the child's both languages, in order to achieve adequate sensitivity, specificity and positive predictive value. This procedure is highly relevant for children from low socio-economic families with a complex linguistic environment who tend to be at an increased risk of severe DLD. Key messages The procedure combining the child’s two languages identified language disorder in bilingual children at age 2.5 compared with assessment in only one language. Child healthcare nurses should screen bilingual children in both their languages in order to reflect their full language capacity equally as in monolingual children.

scholarly journals INDUCTION OF LABOUR;

2019 ◽  
Vol 26 (03) ◽  
Author(s):  
Sana Hafeez ◽  
Musrat Akhter ◽  
Shazia Siddique ◽  
Salma Jabeen
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Cervical Length ◽  
Induction Of Labor ◽  
Bishop Score ◽  
Normal Delivery ◽  
Increased Risk ◽  
The Mean

Background: Increased risk for the baby and higher perinatal mortality are related to birth after 42 weeks. To find out whether a delivery occurs within a span of 24 hours, assessment of cervix through Transvaginal ultrasonography (TVS) and Bishop’s Score are two methods. Objectives: To find out the accuracy of transvaginal ultrasound and Bishop’s Score for cervical length assessment to know the success of induction of labor in primigravidas at term. Setting: Department of Obs and Gynae of Civil Hospital, Bahawalpur. Study Design: Cross sectional study. Period: Nov 1st 2016 to April 30th 2017. Material and Methods: Total 220 females were included through non probability, purposive sampling. Females underwent vaginal examination and Bishop Score was noted and case was labeled as positive or negative. TVS and cervical length was measured and case was labeled as positive or negative. After that, PGE1 50 ug was used and females were waited for labor to be started and normal delivery occurrence. Data was entered and analyzed using SPSS version 16.0. Results: The mean bishop score of females after induction was 6.78±2.66. There were 171 (78%) females who had bishop score >5 while 49 (22%) had bishop score <5. The mean cervical length of females after induction was 26.40±3.69mm. There were 154 (70%) females who had cervical length <27mm while 66 (30%) had cervical length >27mm. The mean induction to delivery interval was 23.01±4.66hours. There were 130 (59%) females who delivered within a period of 24 hours while 90 (41%) delivered after 24 hours. The calculated specificity, sensitivity, positive predictive value, negative predictive value along with diagnostic accuracy of Bishop score were 31%, 84%, 64%, 57% and 62% respectively. The calculated specificity, sensitivity, positive predictive value, negative predictive value along with diagnostic accuracy of cervical length were 59%, 90%, 76%, 80% and 77% respectively. Conclusion: Cervical length assessment on TVS had more accuracy than bishop score in primigravidas presenting at term for induction of labor helping avoidance of post-term pregnancy.

Malignancy Rate, Number Needed to Treat, and Positive Predictive Value for Breast MRI

2016 ◽  
Vol 82 (9) ◽  
pp. 815-819 ◽  
Author(s):  
John S. Kennedy ◽  
Patrick A. Robbins
Keyword(s):  
Breast Cancer ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Breast Mri ◽  
Invasive Cancer ◽  
Number Needed To Treat ◽  
Palpable Mass ◽  
Malignancy Rate ◽  
Increased Risk ◽  
Positive Rate

Breast MRI is being used more frequently for advanced screening for breast cancer. Patients may be at increased risk, or are symptomatic, with nonsuspicious mammograms. There is little data regarding the likelihood of a recommendation for biopsy, or for detecting a malignancy, in this population. We intended to determine the malignancy rate, number needed to treat, and positive predictive value for patients receiving adjunctive MRI at our institution. A retrospective review of all breast MRIs from 2008 to 2010 was done. Patients with any prior diagnosis of breast cancer, or BRCA+ were excluded. There were 324 patients. Most common reasons for ordering the breast MRI included: abnormal test result 130 (44%), palpable mass 74 (23%), family history 58 (18%), breast pain 47 (15%), and nipple discharge 45 (14%). Breast Imaging-Reporting and Data System score (BIRADS) was 1 or 2 in 36 per cent, 4 or 5 in 18 per cent, 3 in 26 per cent, 0 in 10 per cent, and not given in 9 per cent. Biopsy was recommended in 77 (24%), with biopsy actually performed in 57 (18%). Of the eight cancers identified, four (1.2%) were ductal carcinoma in situ (DCIS) and four (1.2%) were invasive cancer, yielding a true-positive rate of 2.5 per cent. Number needed to treat was 40. Positive predictive value was 14 per cent with a false-positive rate of 86 per cent. In this group of generally higher risk women, typically prescreened with mammography, 1.2 per cent had an invasive cancer, and another 1.2 per cent had DCIS. Those who undergo biopsy are 6.1 times more likely to have benign pathology. The efficacy of adjunctive breast MRI could be improved through refinements in indication, test interpretation, or alternative screening strategies.

Sign in / Sign up

Export Citation Format

Share Document