The “Death Diamond”: Death beyond Trauma

2019 ◽  
Vol 85 (7) ◽  
pp. 757-760
Author(s):  
Michael Farrell ◽  
Thomas Marconi ◽  
John Getchell ◽  
Raymond Green ◽  
Mark Cipolle ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Retrospective Review ◽  
Predictive Value ◽  
Median Survival Time ◽  
Trauma Patients ◽  
Invasive Procedures ◽  
Multicenter Studies ◽  
Trauma Population ◽  
Futile Care ◽  
Prognostic Implications

Thromboelastography (TEG) has become a critical tool for the diagnosis, assessment, and management of hyperfibrinolysis and coagulopathy in trauma. In 2015, Chapman et al. of the Denver group coined the term “Death Diamond” (DD) to describe a TEG tracing identified in a unique trauma population. The DD was associated with a 100 per cent positive predictive value for mortality. Given the potential prognostic implications and resource savings associated with validating the DD as a marker of futile care, we sought to further evaluate DD outcomes. A retrospective review of 6850 TEGs, 34 patients (24 trauma and 10 nontrauma), displayed a DD tracing. Through invasive procedures and transfusions, nine DD tracing “normalized,” but, ultimately, this did not impact the outcome because the DD had a positive predictive value of 100 per cent for mortality in both populations. The median survival time in trauma patients was two hours compared with seven hours in nontrauma patients. Overall, this study further validates the predictive value of the DD in a trauma population while also serving as an assessment of the DD in a nontrauma population. Given these findings, a DD may prove to be an indicator of futile care. Further multicenter studies should be conducted to confirm these results.

The role of prostatic urethral biopsies as a staging tool for bladder cancer

2016 ◽  
Vol 10 (4) ◽  
pp. 359-363
Author(s):  
Adam W Nelson ◽  
Richard A Parker ◽  
Karan Wadhwa ◽  
Alexandra J Colquhoun ◽  
William H Turner
Keyword(s):  
Bladder Cancer ◽  
Positive Predictive Value ◽  
Retrospective Review ◽  
Predictive Value ◽  
Frozen Section ◽  
Prostatic Urethra ◽  
Published Data ◽  
Apical Margin ◽  
Single Centre

Objective: To determine the incidence of prostatic urethral involvement in our patient population and how prostatic urethral biopsy correlates with final cystectomy pathology. Patients and methods: We conducted a retrospective review of prostatic urethral biopsies (PUB) performed between February 2008 and April 2012 in a single centre. PUB pathology was correlated with cystectomy pathology. Results: PUB was undergone by 172 patients with a median age of 70 years (range: 37–84 years): There were 35 (20%) patients having a positive PUB and 137 (80%) who were negative. Of the 94 patients who underwent cystectomy, we found that when the entire prostatic urethra was sectioned, 20 (21%) patients had cancer in the prostatic urethra. Cancer was found in 17 (77%) of 22 patients with a positive PUB and in three (4%) out of the 72 with a negative PUB (positive predictive value (PPV) 77%, negative predictive value (NPV) 96%, sensitivity 85% and specificity 93%). In all 94 patients, the prostatic apical margin was negative. Conclusion: Disease in the prostatic urethra affected 20% of patients, consistent with published data. Prostatic urethral apical margins were all negative. Intra-operative frozen section would have missed cancer in the 20 patients with prostatic urethral cancer, whereas PUB identified 17 (85%) of the 20 patients. These data confirm the value of using PUB before cystectomy, in our UK population.

scholarly journals DIAGNOSTIC ACCURACY OF ULTRASOUND IN THE DETECTION OF PNEUMOTHORAX IN CHEST TRAUMA PATIENTS WITH CT AS THE GOLD STANDARD

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Danquale Vance Kynshikhar ◽  
Chaman Lal Kaushal ◽  
Ashwani Tomar ◽  
Neeti Aggarwal
Keyword(s):  
Emergency Department ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Chest Trauma ◽  
Accurate Diagnosis ◽  
Trauma Patients ◽  
Chest Ultrasound

Background: To study the diagnostic accuracy of ultrasound in the detection of pneumothorax in chest trauma patients with CT as the Gold Standard Methods: The present study was conducted from 31th July 2018 to 30th July 2019. A total of 36 patients were enrolled in the study. Results: By chest ultrasound, pneumothorax was detected in 15 of 24 patients. The sensitivity of chest ultrasound for the diagnosis of pneumothorax was 62.5%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 54.14% and accuracy was 75%. Conclusion: Chest ultrasound can play an important role in the emergency department aiding a physician for bedside rapid and accurate diagnosis of pneumothorax without interruption in the resuscitation process and without transferring the patient to the radiology section. Keywords: Ultrasound, CT, Pneumothorax

scholarly journals A prospective study of trauma patients at Gandhi Medical College and associated hospital emergency department, Bhopal, analysing anatomical and physiological scoring systems to predict mortality

2017 ◽  
Vol 5 (3) ◽  
pp. 871
Author(s):  
Moorat Singh Yadav ◽  
Vibhore Agarwal ◽  
Surabhi Garg
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Scoring Systems ◽  
Trauma Patients ◽  
Adult Age ◽  
Medical College ◽  
Life Years ◽  
Gandhi Medical College ◽  
Sensitivity Specificity ◽  
A Prospective Study

Background: Trauma, in a developing country like India, is a leader together with non-communicable diseases, when measured in terms of disability adjusted life years (DALYs) lost. Trauma scoring systems have been shown to decrease the number of preventable deaths caused by trauma. The aim of this study is to compare the various physiological and anatomical scoring systems.Methods: Two hundred and sixty two cases of trauma of adult age group admitted in Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India from 1 July 2014 to 1 December 2014.Results: Out of the 262 patients included in the study, 242 were discharged alive while 20 (7.6%) died. In our study, in of the patients who died it was observed that RTS was significantly low (<7) and ISS and TRISS were significantly high (>/=25 for ISS and >/=50 for TRISS).Conclusions: Of all the scoring system TRISS has got the best sensitivity, specificity and positive predictive value of 83.3% and also miscalculation rate of 1.5 as per the MOTS norms as compared to RTS, which has sensitivity of 90% but low specificity, and ISS which has sensitivity and specificity comparable to TRISS but low positive predictive value.

scholarly journals Carbapenem-Resistant Klebsiella pneumonia Isolated from Patients Admitted in Tertiary Care Hospital in Saudi Arabia

2020 ◽  
pp. 76-85
Author(s):  
Enas Sh. Khater ◽  
AbdAlazim A. AlFaki ◽  
Shehata Said Abd Elmoaty
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Positive Predictive Value ◽  
General Hospital ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Screening Test ◽  
Clinical Isolates ◽  
Invasive Procedures ◽  
Carbapenem Resistant

Background: Carbapenem-resistant klebsiella pneumoniae is an emerging threat worldwide causing high rates of morbidity and mortality Aim: To evaluate the prevalence of carbapenem-resistant K. pneumonia (CRKP), associated risk factors, type of infections caused by CRKP and their antimicrobial susceptibility. To evaluate Carbapenemase Detection Set (D70C) as screening test for CRKP Place and Duration of the Study: A cross sectional study and prospective cohort study was performed from June 2019 to February 2020 in intensive care unit and medical units of Al Quwayiyah General hospital. Methodology: 541 samples were collected from different patient sources. Klebsiella pneumoniae strain was only selected identified to the species level and AST was done using the Vitek-2. Minimum inhibitory concentration (MIC) of meropenem and imipenem was carried out. A Carbapenemase Detection Set (D70C) was used as screening test for CRKP while Modified Hodge test and multiplex PCR as confirmatory tests. Results: A total of 132 isolates were diagnosed as Enterobacteriaceae out of 541 patient samples.78 clinical isolates were klebsiella pneumoniae which were collected. Out of the 78 clinical isolates CRKP were 36 (46.2%) and CSKP were 42 (53.8%).) CRKP cases aged from (18-84 years) with the median patient age 59 year. Seventeen of 36 patients (47.2%) were males. the majority of the nosocomial CRKP infections were pneumonia 12 (33.3%) followed by urinary tract infection 9 (25%). The most common associated disease was diabetes (30%) followed by renal disease (27.8%). For invasive procedures, Urinary catheter was 27(75%) and 29(69%) followed by Mechanical ventilation 25(69.4%) and 22(52.4%) in CRKP and CSKP patients respectively. Reports of PCR for the 41 isolates which sent to regional laboratory for confirmation revealed that 36 isolates had carbapenemase genes; twenty eight (77.8%) K. pneumonia isolates positive for bla OXA-48 and 5 (13.9%) isolates were positive for blaNDM. in 2 (5.6%) bla KPC were detected, one isolate contained blaIMP. 5 isolates contain both blaOXA-48 and blaNDM. The sensitivity of MHT was analysed to be 91.7%. (95%Cl ratio 77.53% - 98.25%) and the specificity was 100% (95%Cl ratio 54.07% to 100%). The positive predictive value was 100% and the Negative predictive value was 66.7% ( 95%Cl ratio 40.36% to 85.53%). The sensitivity of Carbapenemase Detection Set (D70C) was 94.4% (81.34% to 99.32%) and the specificity was 80% (95%Cl ratio 28.36% to 99.49%). The positive predictive value was 97.1% (95%Cl ratio 85.46% to 99.49%).and the Negative predictive value was 66.7% (95%Cl ratio 32.67% to 89.18%). Conclusion: CRKP prevalence was 46.2% among K. pneumoniae isolates in Al Quwayiya General Hospital. Using invasive procedures such as urinary catheters or mechanical ventilator and misuse of antibiotics were risk factors associated with CRKP indicating that infection control guidelines and effective preventive measures should be strictly applied. It is very important to monitor and report changes in antimicrobial-resistant isolates but Carbapenemase Detection Set (D70C) has low specificity makes it less reliable and need PCR confirmation.

scholarly journals Ultrasound Stratification of Hepatic Steatosis Using Hepatorenal Index

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1443
Author(s):  
Stephen I. Johnson ◽  
Daniel Fort ◽  
Kenneth J. Shortt ◽  
George Therapondos ◽  
Gretchen E. Galliano ◽  
...  
Keyword(s):  
Liver Biopsy ◽  
Positive Predictive Value ◽  
Hepatic Steatosis ◽  
Retrospective Review ◽  
Predictive Value ◽  
Liver Steatosis ◽  
Liver Biopsies ◽  
Biopsy Methods

Hepatorenal index (HRI) has been shown to be an effective, noninvasive ultrasound tool to screen patients for those with or without >5% hepatic steatosis. Objective: The aim of this study was to further refine this HRI tool in order to stratify patients according to their degree of liver steatosis and give direction as to which patients should undergo random liver biopsy. Methods: We conducted a retrospective review of 267 consecutive patients from 2015 to 2017 who had abdominal ultrasounds and a subsequent random liver biopsy within one month. The HRI was calculated and compared with the percent steatosis as assessed by histology. Results: An HRI of ≤1.17 corresponds with >95% positive predictive value of ≤5% steatosis. Between HRI values 1.18 and 1.39, performance of steatosis prediction is mixed. However, for values <1.37 there is an increased likelihood of steatosis ≤5% and likewise the opposite for values >1.37. An HRI of ≥1.4 corresponds with >95% positive predictive value of ≥10% steatosis. Conclusion: HRI is an accurate noninvasive tool to quantify degree of steatosis and guide who should undergo random liver biopsy, potentially significantly reducing the total number of necessary liver biopsies.

scholarly journals The Positive Predictive Value of Onconeural Antibody Testing: A Retrospective Review

2018 ◽  
Vol 45 (5) ◽  
pp. 577-579 ◽  
Author(s):  
Adrian Budhram ◽  
Michael W. Nicolle ◽  
Liju Yang
Keyword(s):  
Positive Predictive Value ◽  
Retrospective Review ◽  
Predictive Value ◽  
Test Interpretation ◽  
Antibody Testing ◽  
Single Centre ◽  
Neurologic Diseases ◽  
Onconeural Antibodies ◽  
Onconeural Antibody ◽  
Immune Mediated

AbstractParaneoplastic syndromes (PNS) are immune-mediated neurologic diseases that occur as an indirect effect of malignancy, and can be challenging to diagnose. Onconeural antibodies have a greater than 95% association with cancer, and their presence in a patient with neurologic symptoms is reportedly highly indicative of PNS. However, we performed a single-centre retrospective review to determine the positive predictive value of onconeural antibody testing, and found it to be concerningly low (39%). Recognising the limitations of onconeural antibody testing is critical to ensure accurate test interpretation, avoid unnecessary repeated malignancy screening and prevent the use of potentially hazardous immunotherapy.

A novel agar base medium for drug susceptibility testing of Mycobacterium tuberculosis isolates

2021 ◽  
Author(s):  
Ahmet Yilmaz Coban
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Susceptibility Testing ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Clinical Isolates ◽  
First Line ◽  
Multicenter Studies

Aim: In this study, it was aimed to evaluate AYC.2.2 agar for susceptibility testing of Mycobacterium tuberculosis clinical isolates against first line drugs. Materials & methods: In the present study, 208 M. tuberculosis clinical isolates were tested on AYC.2.2 agar, which was previously validated for the first line drugs isoniazid, rifampicin, streptomycin and ethambutol. Results: Specificity, sensitivity, positive predictive value, negative predictive value and agreement for isoniazid–rifampicin–ethambutol–streptomycin were 100–100–97.2–99.3%, 94.8–94.8–79.3–94.3%, 100–100–82.1–98.03%, 97.03–98.03–96.7–98.08%, 98.07–98.5–94.7-98.07%, respectively. Conclusion: Results had shown that the newly developed AYC.2.2 agar promises as an alternative medium that can be used to perform susceptibility testing of M. tuberculosis isolates. However, further multicenter studies are needed to be used in routine mycobacteriology laboratories.

Dual-energy computed tomography for the diagnosis of acute gouty arthritis

2021 ◽  
Vol 17 ◽  
Author(s):  
Zengfa Huang ◽  
Zuoqin Li ◽  
Jianwei Xiao ◽  
Yuanliang Xie ◽  
Yun Hu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gouty Arthritis ◽  
Dual Energy ◽  
Multicenter Studies ◽  
Acute Gouty Arthritis ◽  
Dual Energy Computed Tomography ◽  
Sensitivity Specificity

Aims: To investigate the diagnostic value of dual-energy computed tomography (DECT) in acute gouty arthritis (AGA) or patients presenting with suspected gouty arthritis. Methods: This retrospective study was performed in a single centre from May 2017 to August 2018. Two hundred and twenty-six patients with an initial diagnosis of AGA in the preceding 15 days were included. All patients were referred for a DECT scan of the affected joints. The diagnosis criteria of gout with the American College of Rheumatology Classification Standard were regarded as the reference standard. Results: Two hundred patients were included in the present study at last. The sensitivity, specificity, positive predictive value, and negative predictive value of DECT in the diagnosis of all AGA were 83.83%, 60.61%, 91.5% and 42.55% respectively. When AGA was subdivided according to the joint site, the sensitivity, specificity, positive predictive value, and negative predictive value were 80.68%, 61.11%, 91.03%, and 39.29% in feet, 93.55%, 40%, 93.55%, and 40% in knees and 87.5%, 71.43%, 91.3%, and 62.5% in ankles, respectively. Conclusions: DECT had a high sensitivity for the diagnosis of AGA. However, the specificity was limited, particularly for the diagnosis of acute gouty knee arthritis. Prospective multicenter studies of large samples will enhance the application of DECT among the AGA patients in the future.

scholarly journals A new weighted injury severity scoring system: better predictive power for adult trauma mortality

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Junxin Shi ◽  
Jiabin Shen ◽  
Motao Zhu ◽  
Krista K. Wheeler ◽  
Bo Lu ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Injury Severity Score ◽  
Predictive Value ◽  
Predictive Power ◽  
Operating Characteristic ◽  
Injury Severity ◽  
Trauma Patients ◽  
Abbreviated Injury Scale ◽  
Severity Scoring ◽  
Body Regions

Abstract Background An accurate injury severity measurement is essential in the evaluation of trauma care and in outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions, and the three AIS involved in the calculation of ISS are given equal weights. The objective of this study was to develop a weighted injury severity scoring (wISS) system for adult trauma patients with better predictive power than the traditional Injury Severity Score (ISS). Methods The 2007–2014 National Trauma Data Bank (NTDB) Research Datasets were used. We identified adult trauma patients from the NTDB and then randomly split it into a study sample and a test sample. Based on the association between mortality and the Abbreviated Injury Scale (AIS) from each of the six ISS body regions in the study sample, we evaluated 12 different sets of weights for the component AIS scores used in the calculation of ISS and selected one best set of weights. Discrimination (areas under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, concordance) and calibration were compared between the wISS and ISS. Results The areas under the receiver operating characteristic curves from the wISS and ISS are all 0.83, and 0.76 vs. 0.73 for patients with ISS = 16–74 and 0.68 vs. 0.53 for patients with ISS = 25–74. The wISS showed higher specificity, positive predictive value, negative predictive value, and concordance when they were compared at similar levels of sensitivity. The wISS had better calibration than the ISS. Conclusions By weighting the AIS from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured adults.

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