scholarly journals Characteristics of patients who had a stroke not initially identified during emergency prehospital assessment: a systematic review

2021 ◽  
pp. emermed-2020-209607
Author(s):  
Stephanie P Jones ◽  
Janet E Bray ◽  
Josephine ME Gibson ◽  
Graham McClelland ◽  
Colette Miller ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
False Negative ◽  
Visual Disturbance ◽  
Screening Tools ◽  
False Negatives ◽  
Presenting Symptoms ◽  
Ischaemic Attack ◽  
Stroke Type ◽  
Key Terms

BackgroundAround 25% of patients who had a stroke do not present with typical ‘face, arm, speech’ symptoms at onset, and are challenging for emergency medical services (EMS) to identify. The aim of this systematic review was to identify the characteristics of acute stroke presentations associated with inaccurate EMS identification (false negatives).MethodWe performed a systematic search of MEDLINE, EMBASE, CINAHL and PubMed from 1995 to August 2020 using key terms: stroke, EMS, paramedics, identification and assessment. Studies included: patients who had a stroke or patient records; ≥18 years; any stroke type; prehospital assessment undertaken by health professionals including paramedics or technicians; data reported on prehospital diagnostic accuracy and/or presenting symptoms. Data were extracted and study quality assessed by two researchers using the Quality Assessment of Diagnostic Accuracy Studies V.2 tool.ResultsOf 845 studies initially identified, 21 observational studies met the inclusion criteria. Of the 6934 stroke and Transient Ischaemic Attack patients included, there were 1774 (26%) false negative patients (range from 4 (2%) to 247 (52%)). Commonly documented symptoms in false negative cases were speech problems (n=107; 13%–28%), nausea/vomiting (n=94; 8%–38%), dizziness (n=86; 23%–27%), changes in mental status (n=51; 8%–25%) and visual disturbance/impairment (n=43; 13%–28%).ConclusionSpeech problems and posterior circulation symptoms were the most commonly documented symptoms among stroke presentations that were not correctly identified by EMS (false negatives). However, the addition of further symptoms to stroke screening tools requires valuation of subsequent sensitivity and specificity, training needs and possible overuse of high priority resources.

scholarly journals Risk of bias from inclusion of patients who already have diagnosis of or are undergoing treatment for depression in diagnostic accuracy studies of screening tools for depression: systematic review

BMJ ◽  
2011 ◽  
Vol 343 (aug18 1) ◽  
pp. d4825-d4825 ◽  
Author(s):  
B. D. Thombs ◽  
E. Arthurs ◽  
G. El-Baalbaki ◽  
A. Meijer ◽  
R. C. Ziegelstein ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Risk Of Bias ◽  
Screening Tools

scholarly journals Causes of misdiagnoses by thyroid fine-needle aspiration cytology (FNAC): our experience and a systematic review

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yanli Zhu ◽  
Yuntao Song ◽  
Guohui Xu ◽  
Zhihui Fan ◽  
Wenhao Ren
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
False Positive ◽  
False Negative ◽  
Diagnostic Errors ◽  
Published Data ◽  
Cystic Lesions ◽  
Adenomatous Hyperplasia ◽  
Sensitivity Specificity

Abstract Objective FNA is a simple, safe, cost-effective and accurate diagnostic tool for the initial screening of patients with thyroid nodules. The aims of this study were to determine the diagnostic utility of FNAC performed in our institution, assess the cytomorphologic features that contribute to diagnostic errors and propose improvement measures. Methods A total of 2781 FNACs were included in the study, and 1122 cases were compared with their histological diagnoses. We retrospectively reexamined our discordant (both false-negative and false-positive) cases and performed a systematic review of previous studies on causes of misdiagnoses. Results When DC V and DC VI were both considered cytologic-positive, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 98.3, 30.9, 94.9, 58.3 and 93.5%, respectively. If DC VI was considered cytologic-positive, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 98.0, 84.0, 99.4, 58.3, and 97.5% respectively. The main cause of false-negative diagnoses was sampling error (13/15, 86.7%), while interpretation error led to the majority of the false-positive diagnoses (38/47, 80.9%). Overlapping cytological features in adenomatous hyperplasia, thyroiditis and cystic lesions were the major factors contributing to interpretation errors, while the size and number of nodules may have led to false-negative diagnoses because of heterogeneity and unsampled areas. Conclusions The sensitivity and PPV of thyroid FNAC in our institution were higher than those in the published data, while the specificity and NPV were lower. Regarding the FNA category DC V, a frozen section analysis during diagnostic lobectomy is necessary. Multiple passes should be performed in various parts of a large nodule or from different nodules to reduce the risk of false-negative findings. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis and cystic lesions to avoid false-positive diagnoses. NIFTP has little effect on diagnostic accuracy and the distribution of diagnostic errors.

scholarly journals Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.: a Systematic Review

2015 ◽  
Vol 54 (2) ◽  
pp. 401-411 ◽  
Author(s):  
Tomer Avni ◽  
Amir Bieber ◽  
Hefziba Green ◽  
Tali Steinmetz ◽  
Leonard Leibovici ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Diagnostic Performance ◽  
False Negative ◽  
Clinical Samples ◽  
Direct Immunofluorescence ◽  
Urinary Antigen ◽  
True Negative ◽  
Consensus Definition

The diagnosis of Legionnaires' disease (LD) is based on the isolation ofLegionellaspp., a 4-fold rise in antibodies, a positive urinary antigen (UA), or direct immunofluorescence tests. PCR is not accepted as a diagnostic tool for LD. This systematic review assesses the diagnostic accuracy of PCR in various clinical samples with a direct comparison versus UA. We included prospective or retrospective cohort and case-control studies. Studies were included if they used the Centers for Disease Control and Prevention consensus definition criteria of LD or a similar one, assessed only patients with clinical pneumonia, and reported data for all true-positive, false-positive, true-negative, and false-negative results. Two reviewers abstracted data independently. Risk of bias was assessed using Quadas-2. Summary sensitivity and specificity values were estimated using a bivariate model and reported with a 95% confidence interval (CI). Thirty-eight studies were included. A total of 653 patients had confirmed LD, and 3,593 patients had pneumonia due to other pathogens. The methodological quality of the studies as assessed by the Quadas-2 tool was poor to fair. The summary sensitivity and specificity values for diagnosis of LD in respiratory samples were 97.4% (95% CI, 91.1% to 99.2%) and 98.6% (95% CI, 97.4% to 99.3%), respectively. These results were mainly unchanged by any covariates tested and subgroup analysis. The diagnostic performance of PCR in respiratory samples was much better than that of UA. Compared to UA, PCR in respiratory samples (especially in sputum samples or swabs) revealed a significant advantage in sensitivity and an additional diagnosis of 18% to 30% of LD cases. The diagnostic performance of PCR in respiratory samples was excellent and preferable to that of the UA. Results were independent on the covariate tested. PCR in respiratory samples should be regarded as a valid tool for the diagnosis of LD.

Screening Tools for Cognitive Impairment in Adults with Substance Use Disorders: A Systematic Review

2021 ◽  
pp. 1-24
Author(s):  
Katherine Y. Ko ◽  
Nicole Ridley ◽  
Shayden D. Bryce ◽  
Kelly Allott ◽  
Angela Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Substance Use ◽  
Cognitive Impairment ◽  
Diagnostic Accuracy ◽  
Substance Use Disorders ◽  
Classification Accuracy ◽  
Risk Of Bias ◽  
Screening Tools ◽  
Cognitive Screening ◽  
Screening Measures

ABSTRACT Objectives: Cognitive impairment is common in individuals with substance use disorders (SUDs), yet no evidence-based guidelines exist regarding the most appropriate screening measure for use in this population. This systematic review aimed to (1) describe different cognitive screening measures used in adults with SUDs, (2) identify substance use populations and contexts these tools are utilised in, (3) review diagnostic accuracy of these screening measures versus an accepted objective reference standard, and (4) evaluate methodology of included studies for risk of bias. Methods: Online databases (PsycINFO, MEDLINE, Embase, and CINAHL) were searched for relevant studies according to pre-determined criteria, and risk of bias and applicability was assessed using the Quality Assessment of Diagnostic Accuracy Studies–2 (QUADAS–2). At each review phase, dual screening, extraction, and quality ratings were performed. Results: Fourteen studies met inclusion, identifying 10 unique cognitive screening tools. The Montreal Cognitive Assessment (MoCA) was the most common, and two novel screening tools (Brief Evaluation of Alcohol-Related Neuropsychological Impairments [BEARNI] and Brief Executive Function Assessment Tool [BEAT]) were specifically developed for use within SUD populations. Twelve studies reported on classification accuracy and relevant psychometric parameters (e.g., sensitivity and specificity). While several tools yielded acceptable to outstanding classification accuracy, there was poor adherence to the Standards for Reporting Diagnostic Accuracy Studies (STARD) across all studies, with high or unclear risk of methodological bias. Conclusions: While some screening tools exhibit promise for use within SUD populations, further evaluation with stronger methodological design and reporting is required. Clinical recommendations and future directions for research are discussed.

scholarly journals Expression of CK-19, galectin-3, and HBME-1 in the differentiation of thyroid lesions: Systematic review and DIAGNOSTIC meta-analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e21151-e21151
Author(s):  
Leandro Luongo Matos ◽  
Adriana Braz Del Giglio ◽  
Carolina MATSUBAYASHI Ogawa ◽  
Michelle de lima Farah ◽  
Maria Aparecida Silva Pinhal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Thyroid Gland ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
False Negative ◽  
Diagnostic Odds Ratio ◽  
Cytokeratin 19 ◽  
Benign Lesions ◽  
Galectin 3 ◽  
Thyroid Lesions

e21151 Background: The distinction between malignant and benign lesions of the thyroid gland often requires histological demonstration, once the fine-needle aspiration biopsy method applied pre-operatively has some limitations. In an attempt to improve diagnostic accuracy, markers have been studied by immunocyto- and immunohistochemistry techniques, mainly cytokeratin-19 (CK-19), galectin-3 (Gal-3) and Hector Battifora mesothelial-1 (HBME-1). However, current results remain controversial. The aim of the present article was to establish the diagnostic accuracy of CK-19, Gal-3 and HBME-1 markers, as well as their associations, in the differentiation of malignant and benign thyroid lesions. Methods: A systematic review of MEDLINE’s published articles was performed. After establishing the inclusion and exclusion criteria, 65 articles were selected. The technique of meta-analysis of diagnostic accuracy was employed, and global values of sensitivity, specificity, area under the ROC curve (AUC), and diagnostic odds ratio (dOR) were calculated. Results: The positivity ofCK-19 for the diagnosis of malignant thyroid lesions demonstrated sensitivity of 81% (IC95%: 79-83%), specificity of 73% (IC95%: 70-75%), AUC of 87,5% and dOR of 14,7 (IC95%: 8,2-26,4); for Gal-3, sensitivity of 82% (IC95%: 81-84%), specificity of 81% (IC95%: 79-82%), AUC of 90% and dOR of 23,4 (IC95%: 14,0-39,1); and for HBME-1, sensitivity of 77% (IC95%: 76-79%), specificity of 83% (IC95%: 82-85%), AUC of 92,8% and dOR of 41,0 (IC95%: 21,4-78,4). The association of the three markers determined sensitivity of 85% (IC95%: 78-90%), specificity of 97% (IC95%: 90-99%), AUC of 93,3% and dOR of 95,1 (IC95%: 25,2-359,1). Conclusions: The search for new molecular markers must continue in order to enhance the diagnostic accuracy of the differentiation between malignant and benign lesions of the thyroid gland, since the results found still show persistency of false-negative and false-positive tests.

scholarly journals Depression Screening Tools for Patients with Kidney Failure

2020 ◽  
Vol 15 (12) ◽  
pp. 1785-1795
Author(s):  
Karli Kondo ◽  
Jennifer R. Antick ◽  
Chelsea K. Ayers ◽  
Devan Kansagara ◽  
Pavan Chopra
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Beck Depression Inventory ◽  
Kidney Failure ◽  
Assessment Tools ◽  
Screening Tools ◽  
Depression Screening ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Patient Health

Background and objectivesPatients with kidney failure experience depression at rates higher than the general population. Despite the Centers for Medicare and Medicaid Services’ ESRD Quality Incentive Program requirements for routine depression screening for patients with kidney failure, no clear guidance exists.Design, setting, participants, & measurementsFor this systematic review, we searched MEDLINE, PsycINFO, and other databases from inception to June 2020. Two investigators screened all abstracts and full text. We included studies assessing patients with kidney failure and compared a tool to a clinical interview or another validated tool (e.g., Beck Depression Inventory II). We abstracted data related to sensitivity and specificity, positive and negative predictive value, and the area under the curve. We evaluated the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies 2.ResultsA total of 16 studies evaluated the performance characteristics of depression assessment tools for patients with kidney failure. The Beck Depression Inventory II was by far the best studied. A wide range of thresholds were reported. Shorter tools in the public domain such as the Patient Health Questionnaire 9 and Geriatric Depression Scale 15 (adults over 60) performed well but were not well studied. Short tools such as the Beck Depression Inventory–Fast Screen may be a good option for an initial screen.ConclusionsThere is limited research evaluating the diagnostic accuracy of most screening tools for depression in patients with kidney failure, and existing studies may not be generalizable to US populations. Studies suffer from limitations related to methodology quality and/or reporting. Future research should target widely used, free tools such as the Patient Health Questionnaire 2 and the Patient Health Questionnaire 9.Clinical Trial registry name and registration number:Systematic Review Registration: PROSPERO CRD42020140227.

Improving Detection of Amnestic Mild Cognitive Impairment with Sex-Specific Cognitive Norms

2021 ◽  
pp. 1-8
Author(s):  
Erin E. Sundermann ◽  
Lisa L. Barnes ◽  
Mark W. Bondi ◽  
David A. Bennett ◽  
David P. Salmon ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Diagnostic Accuracy ◽  
Diagnostic Criteria ◽  
Verbal Memory ◽  
False Negative ◽  
Amnestic Mild Cognitive Impairment ◽  
False Positives ◽  
Cut Scores ◽  
False Negatives

Background Despite a female advantage in verbal memory, normative data for verbal memory tests used to diagnose Alzheimer’s disease (AD) dementia and amnestic mild cognitive impairment (aMCI) often are not sex-adjusted. Objective To determine whether sex-adjusted norms improve aMCI diagnostic accuracy when accuracy was evaluated by progression to AD dementia over time. Methods Non-sex-specific and sex-specific verbal memory test norms were incorporated into Jak/Bondi aMCI criteria and applied to older (age 65–90) non-demented women (N = 1,036) and men (N = 355) from the Rush Memory and Aging Project. Using sex-specific aMCI diagnosis as the “true” condition versus non-sex-specific aMCI diagnosis as the “predicted” condition, we identified True Positives, False Positives, True Negatives, and False Negatives and compared AD dementia risk over 10 years among groups. Results Rates of aMCI were higher in men versus women (χ 2 = 15.39, p <  0.001) when determined based on typical diagnostic criteria, but this difference reversed when using sex-specific diagnostic criteria (χ 2 = 8.38, p = 0.004). We identified 8%of women as False Negatives and 12%of men as False Positives. Risk of incident AD dementia in False Positive men was significantly lower than in True Positive men (HR = 0.26, 95%CI = 0.12–0.58, p = 0.001). Risk of incident AD dementia in False Negative women was substantially higher than in True Negative women (HR = 3.11, 95%CI = 2.09–4.63, p <  0.001). Conclusion Results suggest that previous reports of higher aMCI rates in men versus women may be an artifact of non-sex-adjusted norms/cut-scores. Incorporation of sex-specific norms/cut-scores for verbal memory impairment into aMCI diagnostic criteria may improve diagnostic accuracy and avoid diagnostic errors in approximately 20%.

Abstract TP375: Screening for Nontraditional Stroke Symptoms in Women: What is the Evidence? A Systematic Review

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Renee Colsch
Keyword(s):  
Systematic Review ◽  
Los Angeles ◽  
Patient Outcomes ◽  
Screening Tool ◽  
Early Recognition ◽  
The United States ◽  
Screening Tools ◽  
Medical Subject Headings ◽  
Key Terms ◽  
Timely Treatment

Background and Purpose: Stroke is the fifth leading cause of death in the United States. It is projected by the year 2030, there will be a 20.5% increase in the prevalence of stroke, with women being at highest risk. Women can present with nontraditional symptoms of stroke. The purpose of this review of literature was to determine the accuracy, reliability, validity, and sensitivity of existing stroke screening tools that incorporate nontraditional symptoms, and examine gender differences. Methods: A systematic review of peer-reviewed literature was completed in five databases: CINAHL Google Scholar, ProQuest, PubMed, and SCOPUS. Websites were scanned for gray material. Key terms where utilized as text words, title, abstract and medical subject headings to identify related studies of relevance. Results: References were screened by title and abstract. Twenty-nine out of 1175 articles met the inclusion criteria. Seven stroke screening tools were identified; Melbourne Ambulance Stroke Screen, Los Angeles Prehospital Stroke Screen (LAPSS), Cincinnati Prehospital Stroke Scale, Ontario Prehospital Stroke Screening Tool, Medic Prehospital Assessment for Code Stroke, the Recognition of Stroke in the Emergency Room, and Face Arm Speech Test. A thematic synthesis approach organizing data according to patterns identified: early recognition of stroke is crucial to timely treatment and better patient outcomes, a difference in stroke symptoms exists between genders, knowledge and awareness of nontraditional stroke symptoms are essential for early identification, current stroke screen tools have a potential for nearly 30% error of non-identification of stroke, and only 2 of 7 screening tools identify more than 1 of 11 non-traditional symptoms with the most encouraging tool (LAPSS) only identifying 3 symptoms (loss of consciousness, confusion, and seizures). Conclusions: Evidence suggests limitations exists within current stroke screens. Poor recognition of nontraditional symptoms due to lack of stroke screening tools may delay treatment and worsen patient outcomes. Research is required to identify variables and develop a stroke screening tool that is sensitive and specific to nontraditional stroke symptoms in women.

scholarly journals Home-based screening tools for amblyopia: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e051830
Author(s):  
Samantha Sii ◽  
Chung Shen Chean ◽  
Helen J Kuht ◽  
Mervyn G Thomas ◽  
Sohaib R Rufai
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Gold Standard ◽  
Well Being ◽  
Screening Tools ◽  
Health Concern ◽  
Primary Data ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Home Based

IntroductionAmblyopia is an important public health concern associated with functional vision loss and detrimental impact on the physical and mental well-being of children. The gold standard for diagnosis of amblyogenic conditions currently involves screening by orthoptists and/or ophthalmologists. The bloom of technology enables the use of home-based screening tools to detect these conditions at an early stage by the layperson in community, which could reduce the burden of screening in the community, especially during restrictions associated with the COVID-19 pandemic. Here, we propose a systematic review aiming to evaluate the accuracy and reliability of home-based screening tools compared with the existing gold standard.Methods and analysisWe aim to search for studies involving home-based screening tools for amblyopia among children aged under 18 years. Oxford Centre for Evidence-Based Medicine Level 4 evidence and above will be included, without language or time restrictions. The following platforms will be searched from inception to 31 August 2021: PubMed, Medline, The Cochrane Library, Embase, Web of Science Core Collection and Clinicaltrials.gov. Two independent reviewers will identify studies for inclusion based on a screening questionnaire. The search and screening will start on 14 August 2021 until 1 October 2021. We aim to complete our data analysis by 30 November 2021. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool for diagnostic accuracy studies only. Our primary outcome measure is the diagnostic accuracy of home-based screening tools, while secondary outcome measures include validity, feasibility, reproducibility and cost-effectiveness, where available.Ethics and disseminationEthical approval is not necessary as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication.PROSPERO registration numberCRD42021233511.

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