scholarly journals Validation and Application of Predictive Models for Inadequate Bowel Preparation in Colonoscopies in a Tertiary Hospital Population

2021 ◽  
pp. 1-7
Author(s):  
Edgar Afecto ◽  
Ana Ponte ◽  
Sónia Fernandes ◽  
Catarina Gomes ◽  
João Paulo Correia ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Bowel Preparation ◽  
Predictive Value ◽  
Tricyclic Antidepressants ◽  
Quality Criterion ◽  
Roc Curves ◽  
Tertiary Hospital ◽  
Asa Score ◽  
Inadequate Bowel Preparation ◽  
Sensitivity Specificity

<b><i>Background:</i></b> Bowel preparation is a major quality criterion for colonoscopies. Models developed to identify patients with inadequate preparation have not been validated in external cohorts. We aim to validate these models and determine their applicability. <b><i>Methods:</i></b> Colonoscopies between April and November 2019 were retrospectively included. Boston Bowel Preparation Scale ≥2 per segment was considered adequate. Insufficient data, incomplete colonoscopies, and total colectomies were excluded. Two models were tested: model 1 (tricyclic antidepressants, opioids, diabetes, constipation, abdominal surgery, previous inadequate preparation, inpatient status, and American Society of Anesthesiology [ASA] score ≥3); model 2 (co-morbidities, tricyclic antidepressants, constipation, and abdominal surgery). <b><i>Results:</i></b> We included 514 patients (63% males; age 61.7 ± 15.6 years), 441 with adequate preparation. The main indications were inflammatory bowel disease (26.1%) and endoscopic treatment (24.9%). Previous surgery (36.2%) and ASA score ≥3 (23.7%) were the most common comorbidities. An ASA score ≥3 was the only identified predictor for inadequate preparation in this study (<i>p</i> &#x3c; 0.001, OR 3.28). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of model 1 were 60.3, 64.2, 21.8, and 90.7%, respectively. Model 2 had a sensitivity, specificity, PPV, and NPV of 57.5, 67.4, 22.6, and 90.5%, respectively. The AUC for the ROC curves was 0.62 for model 1, 0.62 for model 2, and 0.65 for the ASA score. <b><i>Conclusions:</i></b> Although both models accurately predict adequate bowel preparation, they are still unreliable in predicting inadequate preparation and, as such, new models, or further optimization of current ones, are needed. Utilizing the ASA score might be an appropriate approximation of the risk for inadequate bowel preparation in tertiary hospital populations.

Risk factors for inadequate bowel preparation: a validated predictive score

Endoscopy ◽  
2017 ◽  
Vol 49 (06) ◽  
pp. 536-543 ◽  
Author(s):  
Antonio Gimeno-García ◽  
Jose Baute ◽  
Goretti Hernandez ◽  
Dalia Morales ◽  
Carmen Gonzalez-Pérez ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Predictive Value ◽  
Validation Cohort ◽  
Area Under The Curve ◽  
Pelvic Surgery ◽  
Predictive Score ◽  
Co Morbidity ◽  
Inadequate Bowel Preparation ◽  
Sensitivity Specificity ◽  
Preparation Strategy

Abstract Background and study aim Inadequate bowel cleansing negatively affects the efficiency of colonoscopy in routine clinical practice. The aim of this study was to design and validate a predictive model for inadequate bowel cleanliness. Patients and methods The model was built from 667 consecutive outpatients (development cohort) who were prospectively scheduled for colonoscopy between June and September 2014. The validation cohort included 409 outpatients who underwent colonoscopy between October and December 2014. Cleansing was evaluated using the Boston Bowel Preparation Scale (BBPS). Bowel preparation was administered on the same day as the examination. Results In the development cohort, BBPS was adequate in 541 patients (81.1 %). At multivariate analysis, antidepressants (odds ratio [OR] 4.25, 95 % confidence interval [CI] 1.91 – 9.47), co-morbidity (OR 3.35, 95 %CI 2.16 – 5.18), constipation (OR 2.09, 95 %CI 1.29 – 3.40), and abdominal/pelvic surgery (OR 1.60, 95 %CI 1.03 – 2.47) were independent predictors for inadequate cleansing. The model built with these variables showed an area under the curve of 0.72 in the development cohort and 0.70 in the validation cohort. A cutoff of 1.225 predicted inadequate bowel preparation with a sensitivity, specificity, positive predictive value, and negative predictive value of 60.3 % (95 %CI 51.6 – 68.4), 75.4 % (95 %CI 71.6 – 78.9), 36.4 % (95 %CI 30.1 – 43.1), and 89.1 % (95 %CI 85.9 – 91.6) in the development cohort, and 50.0 % (95 %CI 38.1 – 61.9), 80.0 % (95 %CI 75.3 – 84.2), 35.7 % (95 %CI 26.4 – 45.6), and 87.9 % (95 %CI 83.7 – 91.3) in the validation cohort. Conclusion A simple score may assist the clinician in predicting which patients are at high risk of inadequate bowel cleanliness. This may guide changes in bowel preparation strategy accordingly.

scholarly journals Identification of the most specific markers to differentiate primary pulmonary carcinoma from metastatic gastrointestinal carcinoma to the lung

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Bachar Alabdullah ◽  
Amir Hadji-Ashrafy
Keyword(s):  
Gastrointestinal Tract ◽  
Predictive Value ◽  
Regression Models ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Multivariate Models ◽  
Gastrointestinal Carcinoma ◽  
Lung Tumours ◽  
Napsin A ◽  
Sensitivity Specificity

Abstract Background A number of biomarkers have the potential of differentiating between primary lung tumours and secondary lung tumours from the gastrointestinal tract, however, a standardised panel for that purpose does not exist yet. We aimed to identify the smallest panel that is most sensitive and specific at differentiating between primary lung tumours and secondary lung tumours from the gastrointestinal tract. Methods A total of 170 samples were collected, including 140 primary and 30 non-primary lung tumours and staining for CK7, Napsin-A, TTF1, CK20, CDX2, and SATB2 was performed via tissue microarray. The data was then analysed using univariate regression models and a combination of multivariate regression models and Receiver Operating Characteristic (ROC) curves. Results Univariate regression models confirmed the 6 biomarkers’ ability to independently predict the primary outcome (p < 0.001). Multivariate models of 2-biomarker combinations identified 11 combinations with statistically significant odds ratios (ORs) (p < 0.05), of which TTF1/CDX2 had the highest area under the curve (AUC) (0.983, 0.960–1.000 95% CI). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 75.7, 100, 100, and 37.5% respectively. Multivariate models of 3-biomarker combinations identified 4 combinations with statistically significant ORs (p < 0.05), of which CK7/CK20/SATB2 had the highest AUC (0.965, 0.930–1.000 95% CI). The sensitivity, specificity, PPV, and NPV were 85.1, 100, 100, and 41.7% respectively. Multivariate models of 4-biomarker combinations did not identify any combinations with statistically significant ORs (p < 0.05). Conclusions The analysis identified the combination of CK7/CK20/SATB2 to be the smallest panel with the highest sensitivity (85.1%) and specificity (100%) for predicting tumour origin with an ROC AUC of 0.965 (p < 0.001; SE: 0.018, 0.930–1.000 95% CI).

Comparative Analysis of Diagnostic Value for Shear Wave Elastography and Real-Time Elastographic Imaging for Thyroid Nodules

2019 ◽  
Vol 9 (2) ◽  
pp. 334-338
Author(s):  
Qing Yang ◽  
Wenhong Zhou ◽  
Jiyu Li ◽  
Guojun Wu ◽  
Feng Ding ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Shear Wave ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Shear Wave Elastography ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Sensitivity Specificity

Objective: To compare the diagnostic value of shear wave elastography (SWE) and real-time elastography (RTE) in the diagnosis of benign and malignant thyroid nodules. Methods: A total of 34 patients who ever received thyroidectomy in our hospital from January 2016 to January 2018 were identified. Meanwhile, all the patients received SWE and RTE before surgery, and all the diagnoses were confirmed by pathological examinations. With respect to SWE technique, the Subject Operating Characteristics (ROC) curves were drawn, in order to obtain the optimal threshold and then make differential diagnoses of benign and malignant thyroid nodules. In terms of RTE, the Rago 5 scoring method was utilized to make differential diagnoses of benign and malignant thyroid nodules. Besides, the pathological examinations after surgery could be considered as the golden standard. At last, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SWE and RTE were calculated, respectively. Results: A total of 51 thyroid nodules were identified, and 41 nodules were benign, 10 nodules were malignant. On the basis of ROC curves, with respect to SWE, the best threshold for differential diagnosis of benign and malignant thyroid nodules is 38.3 kPa. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SWE were 72.7% (8/11), 85% (34/40), 82.4% (42/51), 68.4% (13/19), and 87.5% (35/40), respectively. And the diagnostic indicators of RTE were 81.8% (9/11), 87.5% (35/40), 84.3% (43/51), 73.7% (14/19), and 90.0% (36/40). The sensitivity of quasi-static elastography in differential diagnosis of benign and malignant thyroid nodules with diameter ≤1 cm was 87.5% (7/8), and the sensitivity of SWE was 50.0% (5/10). In addition, the accuracy of SWE in differential diagnosis of benign and malignant thyroid nodules with diameter ≥3 cm was 100% (6/6), and the accuracy of RTE for this kind of thyroid nodules was 66.7% (4/6). Conclusion: Both SWE and RTE technology have good application value in differential diagnosis of benign and malignant thyroid nodules. But, SWE is preferable when making diagnosis of benign and malignant thyroid nodules with diameter ≥3 cm, and RTE was superior in detecting benign and malignant thyroid nodules with diameter ≤1 cm.

scholarly journals Validation of a Modified Triage Scale in a Norwegian Pediatric Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Mette Engan ◽  
Asle Hirth ◽  
Håvard Trønnes
Keyword(s):  
Emergency Department ◽  
Negative Predictive Value ◽  
Resource Utilization ◽  
Predictive Value ◽  
Intraclass Correlation ◽  
Tertiary Hospital ◽  
Pediatric Emergency ◽  
Interrater Agreement ◽  
Pediatric Emergency Department ◽  
Sensitivity Specificity

Objective. Triage is a tool developed to identify patients who need immediate care and those who can safely wait. The aim of this study was to assess the validity and interrater reliability of a modified version of the pediatric South African triage scale (pSATS) in a single-center tertiary pediatric emergency department in Norway. Methods. This prospective, observational study included all patients with medical conditions, referred to the pediatric emergency department of a tertiary hospital in Norway from September 1, 2015, to November 17, 2015. Their assigned triage priority was compared with rate of hospitalization and resource utilization. Validity parameters were sensitivity, specificity, positive and negative predictive value, and percentage of over- and undertriage. Interrater agreement and accuracy of the triage ratings were calculated from triage performed by nurses on written case scenarios. Results. During the study period, 1171 patients arrived at the hospital for emergency assessment. A total of 790 patients (67 %) were triaged and included in the study. The percentage of hospital admission increased with increasing level of urgency, from 30 % of the patients triaged to priority green to 81 % of those triaged to priority red. The sensitivity was 74 %, the specificity was 48 %, the positive predictive value was 52 %, and the negative predictive value was 70 % for predicting hospitalization. The level of over- and undertriage was 52 % and 26 %, respectively. Resource utilization correlated with higher triage priority. The interrater agreement had an intraclass correlation coefficient of 0.99 by Cronbach’s alpha, and the accuracy was 92 %. Conclusions. The modified pSATS had a moderate sensitivity and specificity but showed good correlation with resource utilization. The nurses demonstrated excellent interrater agreement and accuracy when triaging written case scenarios.

scholarly journals Soluble myeloid triggering receptor expressed on myeloid cell 1 might have more diagnostic value for bacterial ascites than C-reactive protein

2018 ◽  
Vol 13 (1) ◽  
pp. 456-462
Author(s):  
Qiang Guo ◽  
Chuanqin Xu ◽  
Chao Sun ◽  
Yubao Zhao ◽  
Weifu Zhang
Keyword(s):  
Predictive Value ◽  
Myeloid Cell ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Control Group ◽  
Health Examination ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Sensitivity Specificity ◽  
Medical University

AbstractThe timely and accurate diagnosis of ascites is of great significance for early treatment and prognostication. This study explored the value of soluble myeloid triggering receptor expressed on myeloid cell 1 (sTREM-1) and C-reactive protein (CRP) for assessing ascites. A total of 133 patients with ascites who received treatment at the Affiliated Hospital of Taishan Medical University between September 2015 and September 2017 were retrospectively analyzed. The ascites in 22, 45, 33 and 33 patients were tuberculous, bacterial, tumorous, and transudative, respectively. Healthy volunteers (n=30) who received a health examination at the same hospital during the same period constituted the control group. Before treatment, both ascitic sTREM-1 and CRP showed significant differences among the ascites subgroups (P<0.001), with the highest levels in the bacterial subgroup. Serum sTREM-1 and CRP also showed significant differences among the groups. A correlation analysis showed a positive correlation between sTREM-1 and CRP. ROC curves of the bacterial subgroup showed that when the optimal cutoff point was set to 20.2, the sensitivity, specificity, positive predictive value, and negative predictive value of the serum sTREM-1 index were 0.933, 0.955, 0.914, and 0.965, respectively. sTREM-1 may provide more diagnostic value than CRP for the diagnosis of bacterial ascites.

scholarly journals Significance of CAVI, hs-CRP and Homocysteine in subclinical arteriosclerosis among a healthy population in China

2013 ◽  
Vol 36 (2) ◽  
pp. 81 ◽  
Author(s):  
Jinpeng Zhong ◽  
Yonghong Wang ◽  
Xiaoling Wang ◽  
Fengzeng Li ◽  
Yulei Hou ◽  
...  
Keyword(s):  
Predictive Value ◽  
Area Under The Curve ◽  
High Sensitivity ◽  
Intima Media Thickness ◽  
Roc Curves ◽  
Carotid Intima Media Thickness ◽  
Youden Index ◽  
Healthy Population ◽  
Hs Crp ◽  
Sensitivity Specificity

Purpose: The purpose of this study is to evaluate the ability of cardio-ankle vascular index (CAVI), high-sensitivity C-reactive protein (hs-CRP) levels and homocysteine (Hcy) levels to screen for subclinical arteriosclerosis (subAs) in an apparently healthy population, with the view to obtaining an optimal diagnostic marker or profile for subAs. Methods: Subjects (152) undergoing routine health examinations were recruited and divided into two groups: carotid arteriosclerosis (CA) and non-carotid arteriosclerosis (NCA), according to carotid intima-media thickness (CMIT). CAVI was calculated based on blood pressure and pulse wave velocity. Serum hs-CRP and Hcy levels were also measured. A Receiver Operating Characteristic (ROC) curve was plotted to evaluate the efficacy of each in carotid arteriosclerosis screening. Ten parameter combinations, designated W1 to W10, were compared in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: The levels of all three parameters were significantly higher in the CA group, compared with the NCA group. ROC curves showed that the area under the curve (AUC) for CAVI was 0.708 (95%CI: 0.615-0.800), which is significantly larger than that of either hs-CRP (0.622) or Hcy (0.630), respectively (P < 0.001). Maximum sensitivity (100%) and NPV (100%) were attained with W10, while maximum specificity (86.2%) and PPV (46.7%) were obtained with W7. With W9, the maximum Youden index (0.416) was obtained, with a sensitivity of 77.8% and specificity of 63.8%. Conclusions: CAVI is more effective than hs-CRP or Hcy for subAs screening. The optimal profile was obtained with a combination of CAVI and other parameters.

Changes of miR-130a and ET-1 and Their Predictive Value for In-Stent Restenosis after Percutaneous Coronary Intervention

2020 ◽  
Author(s):  
Hongliang LIU ◽  
Hao QIAN ◽  
Junlin MA ◽  
Qiming DAI ◽  
Mingyue JI
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Predictive Value ◽  
Roc Curves ◽  
Coronary Intervention ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
Before And After ◽  
Independent Risk Factors ◽  
Sensitivity Specificity

Background: To explore the changes of miR-130a and endothelin -1 (ET-1) and their predictive value for instent restenosis (ISR) after percutaneous coronary intervention (PCI). Methods: Overall, 253 patients with coronary heart disease (CHD) treated with PCI in Lianshui County People's Hospital, Huaian, China from April 2013 to May 2016 were selected. The changes of miR-130a and ET-1 levels before and after PCI were compared. The predictive value of miR-130a and ET-1 for ISR was analyzed by receiver operating characteristic (ROC) curves, and the correlation between ISR and miR-130a, ET-1 was analyzed by Kaplan-Meier (K-M) curve. The risk factors of ISR in CHD patients were evaluated by logistics regression analysis. Results: The postoperative levels of miR-130a and ET-1 were significantly increased (P<0.05). The levels of miR-130a and ET-1 in peripheral blood of patients with ISR were higher than those in patients without ISR (P<0.05). The ROC curves showed that the area under curve (AUC), sensitivity, specificity and critical value of miR-130a in predicting ISR were respectively 0.912, 92.02%, 73.47%, 1.457 pmol/L, and those of ET-1 were 0.814, 87.63%, 63.27%, 2.245 pmol/L, respectively. The K-M curve showed that the incidence of ISR in patients with high expression of miR-130a or ET-1 was significantly higher than that in patients with low expression (P<0.05). miR-130a and ET-1 were independent risk factors for ISR (P<0.05). Conclusion: MiR-130a and ET-1 have high predictive value for ISR after PCI and are independent risk factors for CHD patients, which are worthy of clinical application.

scholarly journals Clinical availability of SNOOP4 in acute non-traumatic headache patients admitted to the emergency department

2020 ◽  
pp. 102490792092868
Author(s):  
Wachira Wongtanasarasin ◽  
Borwon Wittayachamnankul
Keyword(s):  
Emergency Department ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Primary Headache ◽  
Tertiary Hospital ◽  
Adult Patients ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Sensitivity Specificity

Objectives: Non-traumatic headache accounts for up to 4.5% of all patients presenting to the emergency department. Non-traumatic headache is generally classified into two categories: primary and secondary headache disorders. Differentiating secondary from primary headache disorders is essential. SNOOP4 is known as a mnemonic for suggesting clinicians send neuroimaging to rule out serious conditions. Yet, the benefit of using this mnemonic in the emergency department is not well established. This study aimed to assess the significance of SNOOP4 in detecting serious causes of non-traumatic headache in adults presenting to the emergency department. Methods: We conducted a prospective observational study of adult patients presenting to the emergency department of the single tertiary hospital over a period of 12 months. Patients with acute non-traumatic headache presented at the emergency department were included. A standard record form was used. Patients were investigated and treated following the pre-existing protocols. Results were interpreted by attending radiologists. Each factor, according to SNOOP4, was then evaluated for the ability to predict serious causes of non-traumatic headache. Results: A total of 90 patients were included in this study with complete details obtained on 83 (92.2%) patients. Of these, 63 (75.9%) were female. The mean age was 44.5 years (inter-quartile range: 27–58.5). The duration of the headache ranged from 10 min to 7 days. Out of 83, 27 (32.5%) had at least one SNOOP4 criterion. In all, 25 patients (30.1%) underwent neuroimaging. The sensitivity, specificity, positive predictive value, and negative predictive value of SNOOP4 were 77.8%, 73.0%, 25.9%, and 96.4% respectively. Conclusion: SNOOP4 criteria show very high negative predictive value for excluding serious causes of acute non-traumatic headache in adult patients presenting to the emergency department.

scholarly journals Comparison of biparametric and multiparametric MRI in the diagnosis of prostate cancer

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lili Xu ◽  
Gumuyang Zhang ◽  
Bing Shi ◽  
Yanhan Liu ◽  
Tingting Zou ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Multiparametric Mri ◽  
Dce Mri ◽  
Prostate Imaging ◽  
The Difference ◽  
Sensitivity Specificity

Abstract Purpose To compare the diagnostic accuracy of biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) and to explore the application value of dynamic contrast-enhanced (DCE) MRI in prostate imaging. Methods and materials This study retrospectively enrolled 235 patients with suspected PCa in our hospital from January 2016 to December 2017, and all lesions were histopathologically confirmed. The lesions were scored according to the Prostate Imaging Reporting and Data System version 2 (PI-RADS V2). The bpMRI (T2-weighted imaging [T2WI], diffusion-weighted imaging [DWI]/apparent diffusion coefficient [ADC]) and mpMRI (T2WI, DWI/ADC and DCE) scores were recorded to plot the receiver operating characteristic (ROC) curves. The area under the curve (AUC), accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for each method were calculated and compared. The patients were further stratified according to bpMRI scores (bpMRI ≥3, and bpMRI = 3, 4, 5) to analyse the difference in DCE MRI between PCa and non-PCa lesions (as well as between csPCa and non-csPCa). Results The AUC values for the bpMRI and mpMRI protocols for PCa were comparable (0.790 [0.732–0.840] and 0.791 [0.733–0.841], respectively). The accuracy, sensitivity, specificity, PPV and NPV of bpMRI for PCa were 76.2, 79.5, 72.6, 75.8, and 76.6%, respectively, and the values for mpMRI were 77.4, 84.4, 69.9, 75.2, and 80.6%, respectively. The AUC values for the bpMRI and mpMRI protocols for the diagnosis of csPCa were similar (0.781 [0.722–0.832] and 0.779 [0.721–0.831], respectively). The accuracy, sensitivity, specificity, PPV and NPV of bpMRI for csPCa were 74.0, 83.8, 66.9, 64.8, and 85.0%, respectively; and 73.6, 87.9, 63.2, 63.2, and 87.8%, respectively, for mpMRI. For patients with bpMRI scores ≥3, positive DCE results were more common in PCa and csPCa lesions (both P = 0.001). Further stratification analysis showed that for patients with a bpMRI score = 4, PCa and csPCa lesions were more likely to have positive DCE results (P = 0.003 and P < 0.001, respectively). Conclusion The diagnostic accuracy of bpMRI is comparable with that of mpMRI in the detection of PCa and the identification of csPCa. DCE MRI is helpful in further identifying PCa and csPCa lesions in patients with bpMRI ≥3, especially bpMRI = 4, which may be conducive to achieving a more accurate PCa risk stratification. Rather than omitting DCE, we think further comprehensive studies are required for prostate MRI.

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