Clinical Examination is Superior to Plain Films to Diagnose Pelvic Fractures Compared to CT

2008 ◽  
Vol 74 (6) ◽  
pp. 476-480 ◽  
Author(s):  
TherÈSe M. Duane ◽  
Tracey Dechert ◽  
Luke G. Wolfe ◽  
Holly Brown ◽  
Michel B. Aboutanos ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Negative Predictive Value ◽  
Blunt Trauma ◽  
Clinical Examination ◽  
Glasgow Coma Scale Score ◽  
Predictive Value ◽  
Screening Tool ◽  
Pelvic Fractures ◽  
Plain Films ◽  
The Right

We prospectively compared clinical examination (CE) with plain films (PXR) and both tools with CT in patients sustaining blunt trauma. There were 1388 patients who had both PXR and CT of whom 168 (12.1%) were diagnosed with a fracture by CT. CE findings most predictive of fracture included age (OR, 1.025; CI, 1.011–1.039), hip pain (OR, 4.971; CI, 2.508–9.854), internal rotation of the leg (OR, 4.880; CI, 1.980–12.027), or tenderness to palpation over the sacrum (OR, 2.297; CI, 1.144–4.612), over the right or left hip (OR, 3.626; CI, 1.823–7.214), or diffusely throughout the pelvis (OR, 16.445; CI, 4.277–63.237). These factors were still predictive of pelvic fractures even in patients with a Glasgow Coma Scale score less than 13. There were 136 fractures identified by PXR all of which were identified by CE (sensitivity 100% [136 of 136], negative predictive value 100% [619 of 619]). There were six patients with negative clinical examinations and positive CTs (sensitivity 96.4% [162 of 168], negative predictive value 99.03% [613 of 619]), none of which were hemodynamically significant. The sensitivity for PXR compared with CT was 79.17 per cent (133 of 168) and the NPV was 97.2 per cent (1217 of 1252). CE is a reliable way to diagnose pelvic fractures and PXR is a poor screening tool for these injuries compared with CT. Because the majority of patients undergo CT after blunt trauma, routine screening radiographs should be eliminated.

scholarly journals Agreement in the diagnosis of dental fluorosis in central incisors performed by a standardized photographic method and clinical examination

2009 ◽  
Vol 25 (5) ◽  
pp. 1017-1024 ◽  
Author(s):  
Carolina Castro Martins ◽  
Loliza Chalub ◽  
Ynara Bosco Lima-Arsati ◽  
Isabela Almeida Pordeus ◽  
Saul Martins Paiva
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Clinical Examination ◽  
Predictive Value ◽  
Gold Standard ◽  
Dental Fluorosis ◽  
Digital Camera ◽  
High Specificity ◽  
Photographic Method ◽  
Pediatric Dentists

The aim of this study was to assess agreement in the diagnosis of dental fluorosis performed by a standardized digital photographic method and a clinical examination (gold standard). 49 children (aged 7-9 years) were clinically evaluated by a trained examiner for the assessment of dental fluorosis. Central incisors were evaluated for the presence or absence of dental fluorosis and were photographed with a digital camera. Photographs were presented to three pediatric dentists, who examined the images. Data were analyzed using Cohen's kappa and validity values. Agreement in the diagnosis performed by the photographic method and clinical examination was good (0.67) and accuracy was 83.7%. The prevalence of dental fluorosis was reported to be higher in the clinical examination (49%) compared with the photographic method (36.7%). The photographic method presented higher specificity (96%) than sensitivity (70.8%), a positive predictive value (PPV) of 94.4% and a negative predictive value (NPV) of 77.4%. The diagnosis of dental fluorosis performed using the photographic method presented high specificity and PPV, which indicates that the method is reproducible and reliable for recording dental fluorosis.

scholarly journals Radio Pathological Correlation of Thyroid Nodules Using Tirads Based Ultrasound Classification and Bethesda Classification for FNAC: a Prospective Study

2020 ◽  
Vol 27 (3) ◽  
pp. 209-213
Author(s):  
Richa TIWARI ◽  
Ruchi GUPTA ◽  
Amit Kumar VERMA ◽  
Sanjeev KUMAR ◽  
Yogita KATIYAR
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Screening Tool ◽  
Observer Variability ◽  
Inter Observer Variability ◽  
High Negative Predictive Value ◽  
Cation System ◽  
A Prospective Study ◽  
Ultrasound Classification

Background: Thyroid gland is afflicted by various pathologies amongst which nodules are the cause of maximum concern because of their malignant potential. With the introduction of high resolution ultrasound and use of Thyroid imaging reporting and data system (TIRADS) classifi cation as a widely used universal grading system, there has been reduced inter-observer variability and increased inter-departmental communication. In this study, we studied the TIRADS ultrasound grading as a screening tool and compared it with the BETHESDA grading on FNAC. Material and methods: 200 patients with thyroid nodules were subjected to ultrasound and USG guided FNAC. Each was assigned a TIRADS and Bethesda grade. Findings were compared to assess the sensitivity, specifi city, PPV (positive predictive value) and NPV (negative predictive value) of ultrasound in differentiating benign from malignant nodules. RESULT: Out of 200 nodules examined, 116 nodules belonged to TIRADS 2 while 44, 13 and 27 belonged to TIRADS 3, 4 and 5 respectively. On FNAC, 162 patients belonged Bethesda 2 & 12, 7, 15 and 4 to Bethesda 3, 4, 5 and 6 respectively. The sensitivity, specifi city, PPV and NPV of ultrasound were found to be 92.3, 90.8, 60 and 98.75 % respectively. Conclusion: TIRADS is an effective risk stratifi cation system which should be routinely used in our clinical practice as it can predict the possibility of a particular nodule for being malignant to a great extent. Especially keeping in mind its high negative predictive value, FNAC can be deferred in TIRADS 2 patients which form a majority of cases reporting to pathology department for thyroid FNAC.

The Negative Predictive Value of Clinical Examination With or Without Anesthesia Versus Magnetic Resonance Imaging for Parametrial Infiltration in Cervical Cancer Stages IB1 to IIA

2013 ◽  
Vol 23 (1) ◽  
pp. 193-198 ◽  
Author(s):  
Suzanne M. Bleker ◽  
Shandra Bipat ◽  
Anje M. Spijkerboer ◽  
Jacobus van der Velden ◽  
Jaap Stoker ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cervical Cancer ◽  
Magnetic Resonance ◽  
Negative Predictive Value ◽  
Clinical Examination ◽  
Predictive Value ◽  
Academic Medical Center ◽  
Clinical Staging ◽  
Resonance Imaging ◽  
Significant Difference

ObjectiveThis study aimed to compare the negative predictive value (NPV) of clinical examination with or without anesthesia and magnetic resonance imaging (MRI) in identifying patients with cervical carcinoma without parametrial infiltration.MethodsThis retrospective cohort study was conducted at the Academic Medical Center in Amsterdam. The medical files of 203 patients diagnosed with cervical cancer stages IB1-IIA, who underwent surgical treatment between January 1, 2003, and January 31, 2011, were reviewed. We compared clinical International Federation of Gynecology and Obstetrics staging and MRI during the staging procedure. The results were compared with the parametrial status by surgical-pathological investigation, which was considered to be the reference standard.ResultsBased on the surgical-pathological findings, 16.7% of the patients treated surgically had parametrial infiltration. For parametrial infiltration, examination under anesthesia (EUA) had an NPV of 65.3% and MRI of 76.9%, respectively. We found no significant difference between these NPVs.ConclusionsExamination under anesthesia and MRI are equal in identifying cervical cancer patients without parametrial infiltration with a tendency for MRI to perform better than EUA. When outpatient clinical staging is considered inconclusive, pretreatment staging may be limited to MRI. In these cases, EUA seems to have no additional value.

scholarly journals The value of clinical examination in diagnosing pelvic fractures in blunt trauma patients: a brief review

2011 ◽  
Vol 37 (4) ◽  
pp. 373-377 ◽  
Author(s):  
T. A. W. den Boer ◽  
M. Geurts ◽  
L. T. van Hulsteijn ◽  
A. Mubarak ◽  
J. Slingerland ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Clinical Examination ◽  
Pelvic Fractures ◽  
Trauma Patients

scholarly journals Relationship between Clinical, MRI, and Arthroscopic Findings: A Guide to Correct Diagnosis of Meniscal Tears

Joints ◽  
2017 ◽  
Vol 05 (03) ◽  
pp. 164-167
Author(s):  
P. Antinolfi ◽  
R. Cristiani ◽  
F. Manfreda ◽  
S. Bruè ◽  
V. Sarakatsianos ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Prospective Study ◽  
Negative Predictive Value ◽  
Clinical Examination ◽  
Predictive Value ◽  
Gold Standard ◽  
Careful Examination ◽  
Meniscal Tears ◽  
Arthroscopic Findings ◽  
Clinical Mri

Purpose The aim of this prospective study was to compare and correlate clinical, MRI, and arthroscopic findings in cases of suspected meniscal tears. Using arthroscopic findings as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of clinical investigation and MRI were evaluated to determine if is possible, after a careful examination, to bypass MRI and perform directly arthroscopy in suspected cases. Methods A total of 80 patients with a history of knee trauma, preoperative RX, and MRI underwent arthroscopy over an 8-month period at our department. All patients had a clinical examination performed by an experienced knee surgeon. These examiners evaluated and recorded the results of three tests: medial and lateral joint line tenderness test, McMurray's test, and Apley's test. The injury was classified as a meniscal tear if there were at least two positive tests. Finally, using the arthroscopic findings as the gold standard, sensibility, specificity, accuracy, positive and negative predictive values of clinical examination, and MRI were evaluated and compared. Results Clinical examination performed by an experienced knee surgeon reported better sensitivity (91 vs. 85%), specificity (87 vs. 75%), accuracy (90 vs. 82%), positive predictive value (94 vs. 88%), and negative predictive value (81 vs. 71%) than MRI for medial meniscal tears. These parameters showed minimal differences for lateral meniscal tears. Conclusion Clinical examination performed by an experienced knee surgeon provided equal or better results to diagnose meniscal injuries in comparison to MRI. MRI is not necessary to confirm these lesions and should not be used as the primary diagnostic tool. Level of Evidence Level II, prospective study.

scholarly journals CHRONIC VULVAL SYMPTOMS: COMPARISON OF VARIOUS DIAGNOSTIC METHODS

2021 ◽  
Vol 9 (02) ◽  
pp. 310-314
Author(s):  
Akanksha Sharma ◽  
◽  
Saritha Shamsunder ◽  
Niti Khunger ◽  
Geetika Khanna ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Clinical Examination ◽  
Predictive Value ◽  
Diagnostic Methods ◽  
Neoplastic Lesions ◽  
High Negative Predictive Value ◽  
Diagnostic Modalities ◽  
Scrape Cytology

The aim of our study was to compare the various diagnostic modalities for evaluation of chronic vulval symptoms. We studied 100 women presenting with chronic vulval symptoms who underwent examination of vulva with low magnification, scrape cytology, colposcopy & directed biopsy. The overall sensitivity and specificity for detecting vulvar lesions was 29.87% and 100% with low magnification 58.44% and 13.04% with cytology 77.92 % and 17.39 % with colposcopy. We concluded that clinical examination with or without magnification can detect most of the neoplastic lesions. Colposcopy and cytology have high negative predictive value and provide reassurance in absence of disease.

scholarly journals Computed Tomography of the Chest as a Screening Tool for Low Bone Mineral Density

2021 ◽  
Author(s):  
Alan T Vanier ◽  
Donald Colantonio ◽  
Sameer K Saxena ◽  
Daniel Rodkey ◽  
Scott Wagner
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
Femoral Neck ◽  
Negative Predictive Value ◽  
Thoracic Spine ◽  
Predictive Value ◽  
Screening Tool ◽  
Ct Scans ◽  
Mineral Density ◽  
Dxa Scans

ABSTRACT Introduction Computed tomography (CT) Hounsfield units (HU) recently emerged as a promising screening tool for low bone mineral density (BMD). We hypothesized that CT HU measurements of the thoracic spine would significantly and positively correlate with dual X-ray absorptiometry (DXA) BMD scans of the femoral neck. Materials and methods The study included patients with DXA scans and thoracic CT scans at the Walter Reed National Military Medical Center. One author, blinded to the DXA scans, measured HU from the cancellous bone in T4 vertebrae. Another author statistically compared femoral neck DXA T-scores to the CT HU measurements. Results The study included 145 patients with CT scans and femoral neck DXAs. The osteoporotic and osteopenic groups had a significant difference in HU measurements compared to the normal group within the study (P < .0001 and .002, respectively). A low BMD screening value of 231 HU provided a sensitivity of 90.1% and negative predictive value of 85.7%. Conclusion Thoracic vertebrae HU measurements correlate with a low BMD of the femoral neck as determined by DXA T-scores. A high sensitivity and negative predictive value was achieved with a screening value of 231 HU. Utilization of chest or thoracic spine CT imaging as a screening method provides a quick and available screening tool for assessing low BMD in patients with these scans. Level of Evidence: III (Diagnostic)

scholarly journals A Dispatch Screening Tool to Identify Patients at High Risk for COVID-19 in the Prehospital Setting

2021 ◽  
Vol 22 (6) ◽  
pp. 1253-1256
Author(s):  
Amy Albright ◽  
Karen Gross ◽  
Michael Hunter ◽  
Laurel O'Connor
Keyword(s):  
High Risk ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Screening Tool ◽  
Screening Tools ◽  
High Risk Population ◽  
Common Symptom ◽  
Risk Population ◽  
Positive Screen ◽  
The Impact

Introduction: Emergency medical services (EMS) dispatchers have made efforts to determine whether patients are high risk for coronavirus disease 2019 (COVID-19) so that appropriate personal protective equipment (PPE) can be donned. A screening tool is valuable as the healthcare community balances protection of medical personnel and conservation of PPE. There is little existing literature on the efficacy of prehospital COVID-19 screening tools. The objective of this study was to determine the positive and negative predictive value of an emergency infectious disease surveillance tool for detecting COVID-19 patients and the impact of positive screening on PPE usage. Methods: This study was a retrospective chart review of prehospital care reports and hospital electronic health records. We abstracted records for all 911 calls to an urban EMS from March 1–July 31, 2020 that had a documented positive screen for COVID-19 and/or had a positive COVID-19 test. The dispatch screen solicited information regarding travel, sick contacts, and high-risk symptoms. We reviewed charts to determine dispatch-screening results, the outcome of patients’ COVID-19 testing, and documentation of crew fidelity to PPE guidelines. Results: The sample size was 263. The rate of positive COVID-19 tests for all-comers in the state of Massachusetts was 2.0%. The dispatch screen had a sensitivity of 74.9% (confidence interval [CI], 69.21-80.03) and a specificity of 67.7% (CI, 66.91-68.50). The positive predictive value was 4.5% (CI, 4.17-4.80), and the negative predictive value was 99.3% (CI, 99.09-99.40). The most common symptom that triggered a positive screen was shortness of breath (51.5% of calls). The most common high-risk population identified was skilled nursing facility patients (19.5%), but most positive tests did not belong to a high-risk population (58.1%). The EMS personnel were documented as wearing full PPE for the patient in 55.7% of encounters, not wearing PPE in 8.0% of encounters, and not documented in 27.9% of encounters. Conclusion: This dispatch-screening questionnaire has a high negative predictive value but moderate sensitivity and therefore should be used with some caution to guide EMS crews in their PPE usage. Clinical judgment is still essential and may supersede screening status.

scholarly journals Comparison of glasgow coma scale with full outline of unresponsiveness score in measuring consciousness level of endotracheal tube intubated patient in the intensive care unit

2018 ◽  
Vol 6 (6) ◽  
pp. 1882 ◽  
Author(s):  
Yosi Oktarina ◽  
Charles A. Simajuntak
Keyword(s):  
Glasgow Coma Scale ◽  
Endotracheal Tube ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Respiratory Pattern ◽  
Observational Research ◽  
Measurement Tool ◽  
Coma Scale ◽  
Consciousness Level ◽  
Four Score

Background: Assessment of consciousness level is a basic ability that medical personnel, especially doctors and nurses shall master. It is due to assessment of consciousness as a basis of clinical decision making and determining the patient's prognosis. There are various types of scales to measure consciousness level of patient. One of the most famous and most widely applied is Glasgow Coma Scale (GCS). However, the use of GCS is less precise in measuring consciousness level of patients, especially in Endotracheal Tube Intubated patients (ETT). Another measure of consciousness assessment is FOUR Score. In contrast to GCS, the use of four score as a measurement tool for consciousness assessment is still not yet familiar especially in Indonesia. Four score has different component with GCS where the four score component has no assessment of verbal response but it has brainstem and respiratory pattern assessment components.Methods: This research was an observational research using prospective non-experimental approach. The sampling technique used was consecutive sampling with a sample size of 33 people. Observation of the sample was undertaken at the same time. The instruments used in this research were GCS and FOUR Score observation sheet. Data analysis was performed by measuring the sensitivity, specificity, positive predictive value, negative predictive value and ROC.Results: Four Score has sensitivity of 86.7 specificity of 83.3 predictive positive value of 81.3 and negative predictive value 88.2 and under curve area of 0.848. Meanwhile, GCS has sensitivity of 80.0, specificity of 77.8, predictive positive value of 75, and negative predictive value of 82.4 and under curve area of 0.819.Conclusions: Four scores have a better assessment in measuring the consciousness level of ETT intubated patients.

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