scholarly journals AB1126 THE RELIABILITY AND DIAGNOSTIC ACCURACY OF DIGITAL TOMOSYNTHESIS COMPARED WITH CONVENTIONAL RADIOGRAPHY FOR THE INVESTIGATION OF SACROILIITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1852-1852
Author(s):  
A. Rischin ◽  
E. Kathpal ◽  
S. Vogrin ◽  
L. Bentley ◽  
V. Master ◽  
...  
Keyword(s):  
New York ◽  
Diagnostic Accuracy ◽  
Sacroiliac Joint ◽  
Axial Spondyloarthritis ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Conventional Radiography ◽  
Digital Tomosynthesis ◽  
Radiographic Assessment ◽  
Better Than

Background:Conventional radiography remains part of the diagnosis of axial spondyloarthritis and determines qualification for biologic disease modifying anti-rheumatic drugs in many countries. The standard anteroposterior radiograph (XR) incompletely images the complex sacroiliac joint with recognised unacceptably low levels of agreement between readers. Digital tomosynthesis (DTS) uses conventional radiographic projections to create a three-dimensional image and is a potential alternative for the initial radiographic detection and grading of sacroiliitis.Objectives:To compare the level of agreement between two radiologists when reporting sacroiliac joint imaging with digital tomosynthesis versus conventional radiography, as well as to compare the diagnostic accuracy of each imaging modality.Methods:229 consecutive patients that had radiography and digital tomosynthesis performed at Footscray Hospital, Melbourne, Australia were included. Two blinded radiologists independently re-reported all images according to the modified New York criteria, or listed an alternative diagnosis. An overall assessment of each image as inflammatory sacroiliitis, normal or non-inflammatory disease was also recorded. Demographic and clinical data were extracted from medical records. Agreement between and within readers was evaluated using kappa (κ) statistic. Diagnostic accuracy was calculated by comparing each reader’s overall assessment against 2 reference standard comparators: most recent rheumatologist diagnosis and fulfillment of ASAS criteria at any time point.Results:The intra-reader agreement of reader 1 was almost perfect for the left, right and overall sacroiliac joint assessments (κ 0.77 - 0.94), with DTS outperforming XR. Reader 2 agreement was mostly moderate (κ 0.39 - 0.69), with DTS and XR better on the left and right sacroiliac joint respectively, but XR having better overall assessment. The inter-reader agreement of DTS for all patients was moderate and better than XR as shown in the Table. When excluding non-spondyloarthritis patients, inter-reader agreement improved (κ 0.50 to 0.58) but there was no significant difference between DTS and XR. Using reader 1, the sensitivity of DTS (64.8 - 66.7%) was better than XR (54.9 - 60.7%) but low, in keeping with what is known about radiographic sacroiliitis and axial spondyloarthritis. The specificity of XR (78.5 – 80.3%) was better than DTS (72.3 – 73.1%). There were no significant differences when fulfillment of modified New York Criteria was used as a reader’s positive test.Table.Inter-rater reliability between the readersAll patients(N=229)*Inflammatory sacroiliitis & normal patients (N=164)**Inflammatory sacroiliitis patients (N=92)**XR Right0.360.520.56DTS Right0.390.500.51XR Left0.340.550.56DTS Left0.420.550.58XR Overall0.40DTS Overall0.45*Non-weighted kappa statistic**Weighted kappa statisticConclusion:DTS demonstrated moderate reliability for assessment of sacroiliitis, marginally better than conventional radiography. Overall levels of agreement for both imaging modalities were however lower than radiography in previous studies, with several possible contributing factors. A prospective study in a selected spondyloarthritis cohort may better determine any benefit of DTS.References:[1]Christiansen AA, Hendricks O, Kuettel D, Horslev-Petersen K, Jurik AG, Nielsen S, et al. Limited Reliability of Radiographic Assessment of Sacroiliac Joints in Patients with Suspected Early Spondyloarthritis. The Journal of rheumatology. 2017;44(1):70-7.[2]van Tubergen A, Heuft-Dorenbosch L, Schulpen G, Landewe R, Wijers R, van der Heijde D, et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality? Annals of the rheumatic diseases. 2003;62(6):519-25.Disclosure of Interests:None declared

scholarly journals Evaluation of the change in structural radiographic sacroiliac joint damage after 2 years of etanercept therapy (EMBARK trial) in comparison to a contemporary control cohort (DESIR cohort) in recent onset axial spondyloarthritis

2017 ◽  
Vol 77 (2) ◽  
pp. 221-227 ◽  
Author(s):  
Maxime Dougados ◽  
Walter P Maksymowych ◽  
Robert B M Landewé ◽  
Anna Moltó ◽  
Pascal Claudepierre ◽  
...  
Keyword(s):  
New York ◽  
Sacroiliac Joint ◽  
Axial Spondyloarthritis ◽  
Joint Damage ◽  
Control Group ◽  
Progression Rate ◽  
Recent Onset ◽  
Link Type ◽  
Factor Therapy ◽  
Adjusted Least Squares

ObjectiveTo compare 2 years of radiographic sacroiliac joint (SIJ) changes in patients with recent onset axial spondyloarthritis (axSpA) receiving etanercept in a clinical trial (EMBARK) to similar patients not receiving biologics in a cohort study (DESIR).MethodsEndpoints were changes at week 104 per the modified New York (mNY) grading system in total SIJ score (primary endpoint) and net percentage of patients with progression defined three ways. Treatment effect was analysed with and without adjustment for baseline covariates.ResultsAt 104 weeks, total SIJ score improved in the etanercept group (n=154, adjusted least-squares mean change: –0.14) and worsened in the control group (n=182, change: 0.08). The adjusted difference between groups (etanercept minus control) was –0.22 (95% CI –0.38 to –0.06), p=0.008. The net percentage of patients with progression was significantly lower in the etanercept versus the control group for two of three binary endpoints: –1.9% versus 1.6% (adjusted difference for etanercept minus control: –4.7%,95% CI –9.9 to 0.5, p=0.07) for change in mNY criteria; –1.9% versus 7.8% (adjusted difference: –18.2%,95% CI –30.9 to –5.6, p=0.005) for change ≥1 grade in ≥1 SIJ; and –0.6% versus 6.7% (adjusted difference: –16.4%,95% CI –27.9 to –5.0, p=0.005) for change ≥1 grade in ≥1 SIJ, with shift from 0 to 1 or 1 to 0 considered no change.ConclusionDespite the slow radiographic SIJ progression rate over 2 years in axSpA, this study suggests a lower rate of progression in the SIJ with etanercept than without anti-tumour necrosis factor therapy.Trial registration numbersNCT01258738, NCT01648907; Post-results.

scholarly journals MRI compared with low-dose CT scanning in the diagnosis of axial spondyloarthritis

2019 ◽  
Vol 39 (4) ◽  
pp. 1295-1303 ◽  
Author(s):  
Lusi Ye ◽  
Yuncai Liu ◽  
Qinqin Xiao ◽  
Ledan Dong ◽  
Caiyun Wen ◽  
...  
Keyword(s):  
Back Pain ◽  
Sacroiliac Joint ◽  
Chronic Back Pain ◽  
Axial Spondyloarthritis ◽  
Significant Proportion ◽  
High Specificity ◽  
Ct Scanning ◽  
Conventional Radiography ◽  
Plain Radiography ◽  
Inflammatory Back Pain

Abstract Objectives To compare the performance of conventional radiography, ldCT, and MRI in the diagnosis of sacroiliitis in suspected axial spondyloarthritis (axSpA). Methods Patients presenting with > 3 months chronic back pain were assessed by axSpA-experienced rheumatologists and diagnosed as axSpA or not; axSpA patients were then considered nr-axSpA or AS using plain radiography. Non-axSpA patients were recruited as controls, and divided into non-inflammatory and inflammatory groups on the basis of inflammatory back pain and/or CRP/ESR elevation. Clinical variables, pelvic radiography, sacroiliac joint (SIJ) ldCT, and SIJ MRI were obtained. Results A total of 121 patients were included and had SIJ radiography and ldCT, of whom 71 additionally had an SIJ MRI. These included 23 non-inflammatory controls, 21 inflammatory controls, 32 nr-axSpA cases, and 45 AS cases. Fourteen of 32 (44%) nr-axSpA patients had positive ldCT scans, 21/24 (88%) had MRI-BMO, and 11/24 (46%) had MRI-structural lesions. ldCT had high specificity with only 1/23 (4%) non-inflammatory controls being positive. MRI-BMO had the highest sensitivity for nr-axSpA, but compared with ldCT lower specificity, with 5/15 (33%) of non-inflammatory controls being positive, and similar sensitivity for AS (20/22 (91%) vs 44/44 for ldCT). Conclusions ldCT identifies evidence of radiographic change in a significant proportion of nr-axSpA cases and is highly specific for axSpA. MRI-BMO lesions are more sensitive than either conventional radiography or MRI-structural assessment for axSpA. The relative position of these imaging modalities in screening for axSpA needs to be reconsidered, also taking into account the costs involved.Key Points• ldCT is more sensitive for erosions or sclerosis in axSpA than plain radiography, with 44% of patients with nr-axSpA having evidence of AS-related sacroiliac joint changes on ldCT.• MRI-structural lesions are no more sensitive but are less specific for AS than ldCT.• MRI-BMO is the most sensitive test for nr-axSpA of the modalities tested but is less specific for axSpA than for ldCT.

Development and Validation of Three Preliminary MRI Sacroiliac Joint Composite Structural Damage Scores in a 5-year Longitudinal Axial Spondyloarthritis Study

2021 ◽  
pp. jrheum.201075
Author(s):  
Marie Wetterslev ◽  
Mikkel Østergaard ◽  
Inge Juul Sørensen ◽  
Ulrich Weber ◽  
Anne Gitte Loft ◽  
...  
Keyword(s):  
New York ◽  
Sacroiliac Joint ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Joint Damage ◽  
Tumor Necrosis Factor Inhibitor ◽  
Symptom Duration ◽  
Progression Rate ◽  
Advanced Stages ◽  
Research Consortium

Objective In axial spondyloarthritis (axSpA), sacroiliac joint (SIJ) erosion is often followed by fat metaplasia in an erosion cavity (backfill), and subsequently ankylosis. We aimed to combine Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ Structural score for Erosion, Backfill and Ankylosis into 3 versions of a novel preliminary Composite axSpA MRI SIJ Structural Damage Score (CSDS) and test these. Methods Thirty-three axSpA patients followed for 5 years after initiation of tumor necrosis factor inhibitor had MRI of SIJs at baseline, and yearly thereafter. Three versions of CSDSs were calculated based on different weightings of erosion, backfill and ankylosis: Equal weighting: CSDSequal=(erosion x0.5)+backfill+ankylosis; Advanced stages weighting more: CSDSstepwise=(erosion x1)+(backfill x4)+(ankylosis x6); Advanced stages overruling earlier stages (“hierarchical”) with “<” meaning “overruled by”: CSDShierarchical=(erosion x1)<(backfill x4)<(ankylosis x6). Results At baseline all CSDSs correlated positively with SPARCC Fat and Ankylosis, modified New Yorkradiography grading and negatively with BASDAI and SPARCC SIJ Inflammation. CSDSstepwise and CSDShierarchical (not CSDSequal) correlated positively with symptom duration and BASMI, and closer with SPARCC ankylosis and Modified New York-radiography grading than CSDSequal. The adjusted annual progression rate for CSDSstepwise and CSDShierarchical (not CSDSequal) was higher the first year compared with fourth year (p=0.04 and p=0.01). Standardized response mean (baselineweek 46) was moderate for CSDShierarchical (0.64) and CSDSstepwise (0.59) and small for CSDSequal (0.25). Conclusion Particularly CSDSstepwise and CSDShierarchical showed construct validity and responsiveness, encouraging further validation in larger clinical trials. The potential clinical implication is assessment of sacroiliac joint damage progression by one composite score.

scholarly journals CT-like images of the sacroiliac joint generated from MRI using susceptibility-weighted imaging (SWI) in patients with axial spondyloarthritis

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001656
Author(s):  
Dominik Deppe ◽  
Kay-Geert Hermann ◽  
Fabian Proft ◽  
Denis Poddubnyy ◽  
Felix Radny ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Sacroiliac Joint ◽  
Axial Spondyloarthritis ◽  
Spin Echo ◽  
Joint Space ◽  
Added Value ◽  
Susceptibility Weighted Imaging ◽  
Reference Standard ◽  
Joint Level ◽  
A Minor

BackgroundTo analyse the added value of susceptibility-weighted imaging (SWI) compared with standard T1-weighted (T1) MRI for detecting structural lesions of the sacroiliac joint (SIJ) in patients with axial spondyloarthritis (axSpA) using CT as reference standard.Material and methodsSixty-eight patients with suspected or proven axSpA underwent both MRI and CT of the SIJ on the same day. Two readers separately scored CT, T1 and SWI for the presence of erosions, sclerosis and joint space changes using an established 24-region SIJ model. Disagreement was resolved by a third reader. Diagnostic accuracy (McNemar test), Cohen’s kappa (k), sensitivity (SE) and specificity were calculated on the joint level using CT as reference.ResultsIn CT, 38 joints showed erosions, 67 sclerosis and 37 joint space changes. Agreement with CT for erosions was 92.6% (k=0.811 (0.7–0.92)) in SWI and 87.5% (k=0.682 (0.54–0.82)) in T1 (p=0.143) and agreement for sclerosis 84.6% (k=0.69 (0.57–0.81)) and 62.5% (k=0.241 (0.13–0.35)) (p<0.001), respectively. This resulted in superior SE of SWI (81.6% vs 73.7%) for erosions and sclerosis (74.6% vs 23.9%) at a minor expense of SP. No differences were detected for joint space changes.ConclusionIn patients with axSpA, SWI depicts erosions and sclerosis more accurately than T1 spin echo MRI at 1.5 T.

scholarly journals Smart Health System to Detect Dementia Disorders Using Virtual Reality

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 810
Author(s):  
Areej Y. Bayahya ◽  
Wadee Alhalabi ◽  
Sultan H. AlAmri
Keyword(s):  
Virtual Reality ◽  
Clinical Diagnosis ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Health Technology ◽  
P Value ◽  
Functional Evaluation ◽  
Medical Specialties ◽  
Weighted Kappa Statistic ◽  
Smart Health

Smart health technology includes physical sensors, intelligent sensors, and output advice to help monitor patients’ health and adjust their behavior. Virtual reality (VR) plays an increasingly larger role to improve health outcomes, being used in a variety of medical specialties including robotic surgery, diagnosis of some difficult diseases, and virtual reality pain distraction for severe burn patients. Smart VR health technology acts as a decision support system in the diseases diagnostic test of patients as they perform real world tasks in virtual reality (e.g., navigation). In this study, a non-invasive, cognitive computerized test based on 3D virtual environments for detecting the main symptoms of dementia (memory loss, visuospatial defects, and spatial navigation) is proposed. In a recent study, the system was tested on 115 real patients of which thirty had a dementia, sixty-five were cognitively healthy, and twenty had a mild cognitive impairment (MCI). The performance of the VR system was compared with Mini-Cog test, where the latter is used to measure cognitive impaired patients in the traditional diagnosis system at the clinic. It was observed that visuospatial and memory recall scores in both clinical diagnosis and VR system of dementia patients were less than those of MCI patients, and the scores of MCI patients were less than those of the control group. Furthermore, there is a perfect agreement between the standard methods in functional evaluation and navigational ability in our system where P-value in weighted Kappa statistic= 100% and between Mini-Cog-clinical diagnosis vs. VR scores where P-value in weighted Kappa statistic= 93%.

scholarly journals THU0395 EFFICACY OF IXEKIZUMAB ON DISEASE ACTIVITY AND QUALITY OF LIFE IN PATIENTS WITH ACTIVE NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS AND OBJECTIVE SIGNS OF INFLAMMATION, STRATIFIED BY BASELINE CRP/SACROILIAC JOINT MRI STATUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 432-433
Author(s):  
W. P. Maksymowych ◽  
H. Marzo-Ortega ◽  
M. Ǿstergaard ◽  
L. S. Gensler ◽  
J. Ermann ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Treatment Group ◽  
Disease Activity ◽  
Sacroiliac Joint ◽  
Axial Spondyloarthritis ◽  
Physical Component Score ◽  
Research Support ◽  
Advisory Boards ◽  
Sf 36 ◽  
Active Sacroiliitis

Background:Ixekizumab (IXE), a high-affinity anti-interleukin-17A monoclonal antibody, is effective in patients (pts) with active non-radiographic axial spondyloarthritis (nr-axSpA), who had elevated C-reactive protein (CRP) and/or active sacroiliitis on magnetic resonance imaging (MRI).1Objectives:To determine if disease activity and patient-reported outcomes at Week 16 were similar between groups after stratifying pts by CRP/sacroiliac joint (SIJ) MRI status at baseline.Methods:COAST-X (NCT02757352) included pts with active nr-axSpA and objective signs of inflammation, i.e. presence of sacroiliitis on MRI (Assessment of Spondyloarthritis International Society [ASAS]/ Outcome Measures in Rheumatology criteria) or elevation of serum CRP (>5.0 mg/L). Pts were randomized 1:1:1 to receive subcutaneous 80 mg IXE every 4 weeks (Q4W) or Q2W, or placebo (PBO). Depending on the baseline values of CRP and MRI SIJ (Spondyloarthritis Research Consortium of Canada [SPARCC] score), pts in the intent-to-treat population (N=239) were divided into 3 subgroups (CRP >5 and MRI ≥2; CRP ≤5 and MRI ≥2; CRP >5 and MRI <2). Logistic regression analysis with treatment, subgroup, and treatment-by-subgroup interaction was used to detect treatment group differences in ASAS40, Ankylosing Spondylitis Disease Activity Score (ASDAS) <2.1 (low disease activity), and Bath Ankylosing Spondylitis Disease Activity Index 50 (BASDAI50) responses at Week 16. Analysis of covariance model with baseline value, treatment, subgroup, and treatment-by-subgroup interaction was used to detect the treatment group difference in change from baseline in Short Form-36 physical component score (SF-36 PCS).Results:The proportion of pts achieving ASAS40 (primary endpoint), ASDAS <2.1, and BASDAI50 (secondary endpoints) was higher in IXE treatment groups compared to PBO at Week 16 (Figure 1). The response rates in IXE-treated subjects were higher in all subgroups (CRP >5 and MRI ≥2; CRP ≤5 and MRI ≥2; CRP >5 and MRI <2) without consistent differences in efficacy between the subgroups. Similarly, pts in the IXE groups showed improvement in SF-36 PCS scores (secondary endpoint) versus pts on PBO at Week 16 (Figure 2).Conclusion:Pts with active nr-axSpA and objective signs of inflammation at baseline who were treated with IXE showed an overall improvement in the signs and symptoms of the disease. The efficacy was not different between pts with both elevated CRP and active sacroiliitis on MRI and pts with either elevated CRP or active sacroiliitis on MRI.References:[1]Deodhar A, et al.Lancet.2020.Disclosure of Interests:Walter P Maksymowych Grant/research support from: Received research and/or educational grants from Abbvie, Novartis, Pfizer, UCB, Consultant of: WPM is Chief Medical Officer of CARE Arthritis Limited, has received consultant/participated in advisory boards for Abbvie, Boehringer, Celgene, Eli-Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Received speaker fees from Abbvie, Janssen, Novartis, Pfizer, UCB., Helena Marzo-Ortega Grant/research support from: Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Lianne S. Gensler Grant/research support from: Pfizer, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, GSK, Novartis, UCB, Joerg Ermann Grant/research support from: Boehringer-Ingelheim, Pfizer, Consultant of: Abbvie, Eli Lilly, Janssen, Novartis,Pfizer, Takeda, UCB, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Andris Kronbergs Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Gabriel Doridot Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Vladimir Geneus Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Ann Leung: None declared, David Adams Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Martin Rudwaleit Consultant of: AbbVie, BMS, Celgene, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB Pharma

scholarly journals Development of an Automatic Functional Movement Screening System with Inertial Measurement Unit Sensors

2020 ◽  
Vol 11 (1) ◽  
pp. 96
Author(s):  
Wen-Lan Wu ◽  
Meng-Hua Lee ◽  
Hsiu-Tao Hsu ◽  
Wen-Hsien Ho ◽  
Jing-Min Liang
Keyword(s):  
Feature Selection ◽  
Inertial Measurement Unit ◽  
Learning Algorithm ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Classification Model ◽  
Measurement Unit ◽  
Functional Movement ◽  
Inertial Measurement ◽  
Movement Screening

Background: In this study, an automatic scoring system for the functional movement screen (FMS) was developed. Methods: Thirty healthy adults fitted with full-body inertial measurement unit sensors completed six FMS exercises. The system recorded kinematics data, and a professional athletic trainer graded each participant. To reduce the number of input variables for the predictive model, ordinal logistic regression was used for subset feature selection. The ensemble learning algorithm AdaBoost.M1 was used to construct classifiers. Accuracy and F score were used for classification model evaluation. The consistency between automatic and manual scoring was assessed using a weighted kappa statistic. Results: When all the features were used, the predict model presented moderate to high accuracy, with kappa values between fair to very good agreement. After feature selection, model accuracy decreased about 10%, with kappa values between poor to moderate agreement. Conclusions: The results indicate that higher prediction accuracy was achieved using the full feature set compared with using the reduced feature set.

Are the Naranjo Criteria Reliable and Valid for Determination of Adverse Drug Reactions in the Intensive Care Unit?

2005 ◽  
Vol 39 (11) ◽  
pp. 1823-1827 ◽  
Author(s):  
Sandra L Kane-Gill ◽  
Levent Kirisci ◽  
Dev S Pathak
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Drug Reactions ◽  
Reliability And Validity ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Drug Reactions ◽  
Rater Reliability ◽  
Cronbach Alpha

BACKGROUND The Naranjo criteria are frequently used for determination of causality for suspected adverse drug reactions (ADRs); however, the psychometric properties have not been studied in the critically ill. OBJECTIVE To evaluate the reliability and validity of the Naranjo criteria for ADR determination in the intensive care unit (ICU). METHODS All patients admitted to a surgical ICU during a 3-month period were enrolled. Four raters independently reviewed 142 suspected ADRs using the Naranjo criteria (review 1). Raters evaluated the 142 suspected ADRs 3–4 weeks later, again using the Naranjo criteria (review 2). Inter-rater reliability was tested using the kappa statistic. The weighted kappa statistic was calculated between reviews 1 and 2 for the intra-rater reliability of each rater. Cronbach alpha was computed to assess the inter-item consistency correlation. The Naranjo criteria were compared with expert opinion for criterion validity for each rater and reported as a Spearman rank (rs) coefficient. RESULTS The kappa statistic ranged from 0.14 to 0.33, reflecting poor inter-rater agreement. The weighted kappa within raters was 0.5402–0.9371. The Cronbach alpha ranged from 0.443 to 0.660, which is considered moderate to good. The rs coefficient range was 0.385–0.545; all rs coefficients were statistically significant (p < 0.05). CONCLUSIONS Inter-rater reliability is marginal; however, within-rater evaluation appears to be consistent. The inter-item correlation is expected to be higher since all questions pertain to ADRs. Overall, the Naranjo criteria need modification for use in the ICU to improve reliability, validity, and clinical usefulness.

Diagnostic accuracy of enthesis ultrasound in the diagnosis of early spondyloarthritis

2010 ◽  
Vol 70 (3) ◽  
pp. 434-439 ◽  
Author(s):  
Eugenio de Miguel ◽  
Santiago Muñoz-Fernández ◽  
Concepción Castillo ◽  
Tatiana Cobo-Ibáñez ◽  
Emilio Martín-Mola
Keyword(s):  
New York ◽  
Diagnostic Accuracy ◽  
Statistical Significance ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Controlled Study ◽  
Diagnostic Classification ◽  
Hla B27 ◽  
Cross Sectional ◽  
Ultrasound Score

ObjectiveTo determine the sensitivity and specificity of enthesis ultrasound for the diagnostic classification of early spondyloarthritis.MethodsA cross-sectional, blinded and controlled study. Standardised bilateral ultrasound of six entheses (Madrid sonography enthesitis index (MASEI)) was performed. Accepted diagnostic classification criteria were used as the gold standard. Validity was analysed by receiver operating characteristic (ROC) curves. Values of p<0.05 were considered significant.Results113 early spondyloarthritis patients were included (58 women/55 men), 57 non-inflammatory control individuals (29 women/28 men) and 24 inflammatory control individuals (11 women/13 men). The evolution time of spondyloarthritis was 10.9±7.1 months. At least some grade of sacroiliitis on x-ray was present in 59 patients, but only five fulfilled the radiographic sacroiliitis New York criteria. Human leucocyte antigen B27 (HLA-B27) was positive in 42% of patients. No statistical differences were found for the enthesis score among diagnostic spondyloarthritis subtypes form of presentation (axial, peripheral or mixed) or HLA-B27 positivity. The MASEI score achieved statistical significance for gender. The ultrasound score was 23.36±11.40 (mean±SD) in spondyloarthritis patients and 12.26±6.85 and 16.04±9.94 in the non-inflammatory and inflammatory control groups (p<0.001), respectively. The ROC area under the curve was 0.82, and a cut-off point of ≥20 points achieved a likelihood ratio of 5.30 and a specificity of 89.47%.ConclusionsEntheses are affected early in spondyloarthritis, and the incidence of involvement is higher in men and independent of the spondyloarthritis diagnostic subtype, HLA-B27 status or presentation pattern. The enthesis ultrasound score seems to have diagnostic accuracy and may be useful for improving the diagnostic accuracy of early spondyloarthritis.

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