False-negative hypoglycaemic screening test for patients in coma.

Congenital heart disease (CHD) is the most common congenital malformation. Diagnosis of critical congenital heart disease (CCHD), the most severe type of congenital heart disease, in a newborn may be difficult. The addition of CCHD screening, using pulse oximetry, to clinical assessment significantly improves the rate of detection. We conducted a pilot study in Morocco on screening neonates for critical congenital heart disease. This study was conducted in the maternity ward of Mohammed VI University Hospital of Marrakesh, Morocco, and included asymptomatic newborns delivered between March 2019 and January 2020. The screening of CCHD was performed by pulse oximetry measuring the pre- and post-ductal saturation. Screening was performed on 8013/10,451 (76.7%) asymptomatic newborns. According to the algorithm, 7998 cases passed the screening test (99.82%), including one inconclusive test that was repeated an hour later and was normal. Fifteen newborns failed the screening test (0.18%): five CCHD, five false positives, and five CHD but non-critical. One false negative case was diagnosed at 2 months of age. Our results encourage us to strengthen screening for CCHD by adding pulse oximetry to the routine newborn screening panel.

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Preferred screening test for Cushing’s syndrome screening

Endocrinology and Disorders ◽

10.31579/2640-1045/053 ◽

2020 ◽

Vol 4 (1) ◽

pp. 01-05

Author(s):

Ahmed Siddiqi

Keyword(s):

False Positive ◽

Screening Test ◽

False Negative ◽

True Positive ◽

True Negative ◽

Inhaled Steroids ◽

Free Cortisol ◽

Suppression Test ◽

Dexamethasone Suppression ◽

Hospital General

Background: In our practice 24 hours urine collection for free cortisol (24Hr UFC) and overnight dexamethasone suppression test (ONDST) are initial investigations to screen patients for hyper-cortisolism. I audited our practice to find our clinicians’ and patients’ choice of first screening investigation for hyper-cortisolism. Method & material: Electronic and paper medical records of patients who underwent 24Hr UFC and/or ONDST at our hospital over previous consecutive twenty four months were examined. 62 such patients were identified but 12 patients were excluded from analysis. We tried to contact 30 patients over consecutive 48 hours over the phone who underwent both 24Hr UFC and ONDST. We managed to contact 18 patients and asked them two study questions. Data & results: 33 (66%) patients were female and 17 (33%) were male. 20 (40%) had 24Hr UFC alone and 30 (60%) patients had both. In total 80 such investigations completed 30 being ONDST and 50 24hr UFC. 53 (66%) of the investigations were requested by Endocrinologists, 21 (26%) by Hospital General Physicians and 6 (8%) by General practitioners (GP). For UFC 10 (20%) were true positive, 31 (62%) were false positive, 6 (12%) were true negative and 0% false negative. 3 (6%) 24Hr UFC samples were not collected properly and were not processed for results. Out of the total false positives (31 patients), 6 (19.3%) cases were of alcohol excess, 4 (13%) of dépression, 3 (9.7%) of inhaled steroids and 1 (3.2%) of sleep apnea. For the ONDST 7 (23.3%) true positive, 4 (13.3%) false positive 19 (63.4%) true negative and 0% false negative. All 18 patients contacted over the phone answered both questions. 16 preferred ONDST over 24Hr UFC, 1 patient had no preference and 1 patient preferred 24Hr UFC over ONDST. Conclusion: Patients overwhelmingly preferred ONDST as first screening test in contrast to physician’s choice of 24Hr UFC.

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Reappraisal of the Monothermal Warm Caloric Screening Test

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949510401205 ◽

1995 ◽

Vol 104 (12) ◽

pp. 942-945 ◽

Cited By ~ 21

Author(s):

Gary P. Jacobson ◽

Jaynee A. Calder ◽

Katheryn A. Rupp ◽

Valerie A. Shepherd ◽

Craig W. Newman

Keyword(s):

Test Data ◽

Screening Test ◽

False Negative ◽

Failure Criteria

The usefulness of a monothermal warm caloric screening test (MWST) for predicting alternate binaural bithermal test abnormalities has been reexamined. Previously, researchers have reported false-negative rates for the MWST ranging from 0% to over 35%. Alternate binaural bithermal test data from 504 consecutive patients were evaluated with MWST failure criteria of 24.5% and 29%, with and without the addition of failure criteria from subtests of the electronystagmography examination. Sensitivity of the MWST alone was high, and improved with additional failure criteria. The specificity levels were correspondingly high. Results support the use of the MWST with adjunctive failure criteria when patients have otherwise normal electronystagmography findings.

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A Meta-analysis of Clinical Screening Tests for Obstructive Sleep Apnea

Anesthesiology ◽

10.1097/aln.0b013e31819c47b6 ◽

2009 ◽

Vol 110 (4) ◽

pp. 928-939 ◽

Cited By ~ 153

Author(s):

Satya Krishna Ramachandran ◽

Lydia A. Josephs

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Screening Test ◽

Meta Analysis ◽

False Negative ◽

Significant Proportion ◽

Screening Tests ◽

Test Accuracy ◽

Clinical Screening ◽

Obstructive Sleep

The purpose of this meta-analysis is to compare clinical screening tests for obstructive sleep apnea and establish an evidence base for their preoperative use. Diagnostic odds ratios were used as summary measures of accuracy, and false-negative rates were used as measures of missed diagnosis with each screening test in this review. Metaregression revealed that clinical models, logarithmic equations, combined techniques, cephalometry, and morphometry are significant characteristics, whereas body mass index, history of hypertension, and nocturnal choking are significant test elements associated with higher diagnostic accuracy. Test accuracy in repeated validation studies of the same screening test is variable, suggesting an underlying heterogeneity in either the clinical presentation of obstructive sleep apnea or the measured clinical elements of these models. Based on the false-negative rates, it is likely that most of the clinical screening tests will miss a significant proportion of patients with obstructive sleep apnea.

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Contact Thermography as a Screening Test for Deep Venous Thrombosis following Major Hip Surgery

Acta Radiologica ◽

10.1177/028418518802900607 ◽

1988 ◽

Vol 29 (6) ◽

pp. 649-652 ◽

Cited By ~ 1

Author(s):

L. Kjær ◽

S. Winter Christensen ◽

Aa. Vestergaard ◽

A. Bjerg-Nielsen ◽

P. Wille-Jørgensen

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

No Value ◽

Screening Test ◽

False Negative ◽

Lower Limbs ◽

Hip Surgery ◽

Non Invasive ◽

Negative Results ◽

False Negative Results

Contact thermography is a non-invasive, easily handled, and inexpensive investigation for the diagnosis of deep venous thrombosis (DVT) in the lower limbs. In this study 56 patients with total hip replacement were screened for DVT by contact thermography, using bilateral ascending phlebography as reference procedure. Examinations were performed on the seventh postoperative day. All thermograms were evaluated blindly and independently at the end of the study. Phlebography revealed unilateral DVT in six patients. Only two had corresponding findings at thermography, giving four false negative results. Moreover, 14 false positive thermograms were found. Based on the number of legs investigated, the nosographic sensitivity and specificity thus were 33 and 87 per cent, respectively. It is concluded that contact thermography is of no value as a screening test for DVT following major hip surgery.

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A Restructured Approach to Diagnosis of Heparin Induced Thrombocytopenia in a Large Tertiary Hospital

Blood ◽

10.1182/blood-2018-99-114265 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3525-3525

Author(s):

Sriman Swarup ◽

Somedeb Ball ◽

Nimesh Adhikari ◽

Courtney Alice Welch ◽

Jaden Fackrell ◽

...

Keyword(s):

Screening Test ◽

Laboratory Testing ◽

Conflicts Of Interest ◽

False Negative ◽

Serotonin Release ◽

Efficient Manner ◽

Improvement Project ◽

Heparin Induced Thrombocytopenia ◽

Cost Efficacy ◽

4T Score

Abstract Background The standard practice for diagnosis of heparin-induced thrombocytopenia (HIT) involves a combination of 4T score and laboratory tests, such as enzyme immunoassay for detection of antibodies. We noted a lack of widespread use of 4T score in our practice setting. We also found that our laboratory utilized Particle Immunofiltration Assay (PIFA) for HIT screening, which has been shown to have questionable diagnostic utility in HIT diagnosis (Warkentin et al., 2007). The study aims to improve the rate of 4T score usage in conjunction with an improved laboratory diagnostic test for patients with suspected HIT in a cost-efficient manner. Method We initiated a quality improvement project involving the review of all patients with laboratory orders for PIFA testing between March 2017 to March 2018, explicitly assessing for documented 4T scores before the ordering of PIFA. Three of the investigators also calculated 4T scores for these patients at the time of laboratory testing and noted the results of the serotonin release assay (SRA), if ordered. We further collected data on any alternative anti-coagulation used in such patients for a cost-efficacy analysis later. Results A total of 170 PIFA tests were ordered during the period of investigation. Only five (0.02%) of these patients had a documented 4T score at the time of testing. One hundred thirteen patients (66.4%) had a low 4T score per investigator-calculation. Forty-seven patients (27.6%) were noted to have intermediate 4T scores. Lastly, ten patients (0.05%) were observed to have high 4T scores. A total of 32 SRAs were ordered; five of which were positive (four with an intermediate 4T score and one with high 4T score). PIFA was false-negative in two confirmed cases of positive SRA and false-positive in 13 instances of negative SRA. Thus, in this study, the sensitivity of PIFA was noted to be 60%, and specificity was observed to be 50%. Nineteen patients also received alternative parenteral anti-coagulation (fondaparinux or argatroban); seven of these were with low, eight with intermediate, and four with high 4T scores. Conclusion The study highlights the need for improving 4T score usage rates in our hospital as well as a need for switching to an alternative HIT screening test to promote patient safety and cost efficacy. Hence, we have begun the integration of 4T score with laboratory testing into the electronic medical record, alongside a shift in our HIT screening test from PIFA to the recently FDA-approved automated latex immunoturbidimetric assay. We will be continuing analysis of patients with suspected HIT for another six months to assess the effects of the above interventions. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

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Propranolol and Exercise as a Screening Test for Growth Hormone Deficiency

PEDIATRICS ◽

10.1542/peds.57.5.712 ◽

1976 ◽

Vol 57 (5) ◽

pp. 712-714

Author(s):

Bonnie S. Shanis ◽

Thomas Moshang

Keyword(s):

Growth Hormone ◽

Growth Hormone Deficiency ◽

Screening Test ◽

False Negative ◽

Peak Serum ◽

Hormone Deficiency ◽

Adrenergic Blockade ◽

Beta Adrenergic ◽

Effective Screening ◽

Serum Gh

There is a need for a safe, inexpensive, and reliable screening test for growth hormone (GH) reserve. Exercise has been utilized for this purpose but false-negative responses (inadequate GH release in non-GH-deficient patients) has limited the effectiveness of this stimulus as a screening test. Beta-adrenergic blockade (propranolol) was used to enhance the effect of exercise on GH release. Thirty-two non-GH-deficient children and five GH-deficient children were evaluated. All of the non-GH-deficient children responded to propranolol and exercise with serum GH levels exceeding 7 ng/ml. The peak serum GH levels in the five GH-deficient patients did not exceed 4 ng/ml. Propranolol and exercise appears to be an effective screening test for GH function.

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False-negative extension/rotation pre-manipulative screening test on a patient with an atretic and hypoplastic vertebral artery

Manual Therapy ◽

10.1016/s1356-689x(02)00111-x ◽

2003 ◽

Vol 8 (2) ◽

pp. 120-127 ◽

Cited By ~ 23

Author(s):

M.D Westaway ◽

P Stratford ◽

B Symons

Keyword(s):

Vertebral Artery ◽

Screening Test ◽

False Negative

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Urine drug-testing tampering approaches: Turkish probationers

Medicine Science and the Law ◽

10.1177/0025802420956453 ◽

2020 ◽

pp. 002580242095645

Author(s):

Melike Aydoğdu ◽

Serap Annette Akgür

Keyword(s):

Screening Test ◽

Drug Testing ◽

False Negative ◽

Drug Abusers ◽

Eye Drops ◽

Test Results ◽

Positive Ratio ◽

Negative Results ◽

False Negative Results ◽

Urine Drug

The growing numbers of individual and social problems associated with drug abuse necessitate new approaches in drug-testing systems. Equally, drug abusers may attempt to invalidate drug testing using different methods such as adulteration, dilution and substitution. This study aims to investigate tampering methods commonly used by Turkish substance-using probationers and evaluate their effects on toxicological drug-testing results. Initially, probationer urinary screening test results and laboratory substitution documents were evaluated to investigate the dilution and substitution attempt. Additionally, an experimental study was carried out by using readily available household products (bleach, vinegar, drain opener, eye drops) for adulteration. The effect of these agents was investigated for 11‐nor‐9‐carboxy-Δ9‐tetrahydrocannabinol (THC–COOH), amphetamine and 3,4-methylenedioxymethamphetamine (MDMA). It was determined that probationers preferred unbranded products (syringes, nylon bottles, etc.) for urine substitution. To detect dilution, screening test results were evaluated along with creatinine values. The variability of mean creatinine values can change the rate of the before-negative and after-positive ratio. For adulteration method, the high amounts of bleach provided false-negative results for THC–COOH and amphetamine, but spiking in any concentration of bleach affected MDMA results, causing a slight increase. Vinegar did not affect the THC–COOH and amphetamine results. However, false-negative results were observed for MDMA, with high amounts of vinegar-spiked urine samples. Drain opener was added in large quantities, and false-negative results were observed for all analytes. Visine eye drops did not have any effect on THC–COOH or amphetamine, but a high quantity of eye drops had a slight decreasing effect for MDMA.

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