Predicting the risk of respiratory distress in newborns with congenital pulmonary malformations

2021 ◽  
pp. 2100949
Author(s):  
Christophe Delacourt ◽  
Nathalie Bertille ◽  
Laurent J. Salomon ◽  
Makan Rashenas ◽  
Alexandra Benachi ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Volume Ratio ◽  
Predictive Ability ◽  
Population Based ◽  
Term Infants ◽  
Predictive Variable ◽  
Study Results ◽  
Roc Area

ObjectivesMost children with prenatally diagnosed congenital pulmonary malformations (CPM) are asymptomatic at birth. We aimed to develop a parsimonious prognostic model for predicting the risk of neonatal respiratory distress (NRD) in preterm and term infants with CPM, based on the prenatal attributes of the malformation.MethodsMALFPULM is a prospective population-based nationally representative cohort including 436 pregnant women. The main predictive variable was the CPM volume ratio (CVR) measured at diagnosis (CVR first) and the highest CVR measured (CVR max). Separate models were estimated for preterm and term infants and were validated by bootstrapping.ResultsIn total, 67 of the 383 neonates studied (17%) had NRD. For infants born at term (>37 weeks, N=351), the most parsimonious model included CVR max as the only predictive variable (ROC area: 0.70±0.04, negative predictive value: 0.91). The probability of NRD increased linearly with increasing CVR max and remained below 10% for CVR max<0.4. In preterm infants (N=32), both CVR max and gestational age were important predictors of the risk of NRD (ROC area: 0.85±0.07). Models based on CVR first had a similar predictive ability.ConclusionsPredictive models based exclusively on CVR measurements had a high negative predictive value in infants born at term. Our study results could contribute to the individualised general risk assessment to guide decisions about the need for newborns with prenatally diagnosed CPM to be delivered at specialised centers.

scholarly journals Downes score as a clinical assessment for hypoxemia in neonates with respiratory distress

2016 ◽  
Vol 48 (6) ◽  
pp. 342 ◽  
Author(s):  
Anita Rusmawati ◽  
Ekawati L. Haksari ◽  
Roni Naning
Keyword(s):  
Positive Predictive Value ◽  
Respiratory Distress ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Negative Likelihood Ratio ◽  
Cross Sectional Study ◽  
Preterm Neonates ◽  
Term Infants ◽  
Cross Sectional ◽  
Service Training

Background Hypoxemia in neonates with clinical respiratorydistress has a high mortality. Downes score is used as an alternativeto evaluate clinical respiratory distress if blood gas analysisinstrument or pulse oxymetry is not available.Objective To evaluate the validity of Downes score for assessinghypoxemia in neonates with clinical respiratory distress.Methods A cross sectional study was carried out on neonates withclinical respiratory distress hospitalized at level 2 and 3 NeonatalCare Unit and in Emergency Room of Dr. Sardjito GeneralHospital, Yogyakarta. Downes score and oxygen saturationmeasured by a pulse oximetry were compared. Hypoxemia wasdefined as oxygen saturation less than 90% in term and post-term infants, less than 88% in preterm neonates, or Downesscore 2:5 according to Basic Emergency Service Training forObstetry and Neonatology (PONED) in 2007. The accuracy ofDownes score in predicting hypoxemia was assessed by sensitivity,specificity, positive-predictive value, negative-predictive value,and likelihood ratio.Results Eighty nine neonates were evaluated. Downes score hadsensitivity of 88%, specificity of 81 o/o, positive-predictive value of72%, negative- predictive value of 92%, positive likelihood ratio4.53, negative likelihood ratio 0.15, prevalence of 36%, and posttest probability of 72%.Conclusion Downes score can be used as a clinical diagnosticmeans for assessing hypoxemia in clinical respiratory distressedneonates with 88% sensitivity (95% CI 79 to 99), and specificity81% sensitivity (95% CI 70 to 91).

scholarly journals Association between clinical risk scores and mortality in atrial fibrillation: Systematic review and network meta-regression of 669,000 patients

2018 ◽  
Vol 27 (6) ◽  
pp. 633-644 ◽  
Author(s):  
Marco Proietti ◽  
Alessio Farcomeni ◽  
Giulio Francesco Romiti ◽  
Arianna Di Rocco ◽  
Filippo Placentino ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Predictive Ability ◽  
Risk Scores ◽  
Clinical Risk ◽  
Increased Risk ◽  
High Negative Predictive Value ◽  
Meta Regression

Aims Many clinical scores for risk stratification in patients with atrial fibrillation have been proposed, and some have been useful in predicting all-cause mortality. We aim to analyse the relationship between clinical risk score and all-cause death occurrence in atrial fibrillation patients. Methods We performed a systematic search in PubMed and Scopus from inception to 22 July 2017. We considered the following scores: ATRIA-Stroke, ATRIA-Bleeding, CHADS2, CHA2DS2-VASc, HAS-BLED, HATCH and ORBIT. Papers reporting data about scores and all-cause death rates were considered. Results Fifty studies and 71 scores groups were included in the analysis, with 669,217 patients. Data on ATRIA-Bleeding, CHADS2, CHA2DS2-VASc and HAS-BLED were available. All the scores were significantly associated with an increased risk for all-cause death. All the scores showed modest predictive ability at five years (c-indexes (95% confidence interval) CHADS2: 0.64 (0.63–0.65), CHA2DS2-VASc: 0.62 (0.61–0.64), HAS-BLED: 0.62 (0.58–0.66)). Network meta-regression found no significant differences in predictive ability. CHA2DS2-VASc score had consistently high negative predictive value (≥94%) at one, three and five years of follow-up; conversely it showed the highest probability of being the best performing score (63% at one year, 60% at three years, 68% at five years). Conclusion In atrial fibrillation patients, contemporary clinical risk scores are associated with an increased risk of all-cause death. Use of these scores for death prediction in atrial fibrillation patients could be considered as part of holistic clinical assessment. The CHA2DS2-VASc score had consistently high negative predictive value during follow-up and the highest probability of being the best performing clinical score.

scholarly journals Investigating the impact of disease and health record duration on the eMERGE algorithm for rheumatoid arthritis

2020 ◽  
Vol 27 (4) ◽  
pp. 601-605
Author(s):  
Vanessa L Kronzer ◽  
Liwei Wang ◽  
Hongfang Liu ◽  
John M Davis ◽  
Jeffrey A Sparks ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Index Date ◽  
Model Performance ◽  
Area Under The Curve ◽  
Population Based ◽  
Health Record ◽  
The Impact

Abstract Objective The study sought to determine the dependence of the Electronic Medical Records and Genomics (eMERGE) rheumatoid arthritis (RA) algorithm on both RA and electronic health record (EHR) duration. Materials and Methods Using a population-based cohort from the Mayo Clinic Biobank, we identified 497 patients with at least 1 RA diagnosis code. RA case status was manually determined using validated criteria for RA. RA duration was defined as time from first RA code to the index date of biobank enrollment. To simulate EHR duration, various years of EHR lookback were applied, starting at the index date and going backward. Model performance was determined by sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC). Results The eMERGE algorithm performed well in this cohort, with overall sensitivity 53%, specificity 99%, positive predictive value 97%, negative predictive value 74%, and AUC 76%. Among patients with RA duration &lt;2 years, sensitivity and AUC were only 9% and 54%, respectively, but increased to 71% and 85% among patients with RA duration &gt;10 years. Longer EHR lookback also improved model performance up to a threshold of 10 years, in which sensitivity reached 52% and AUC 75%. However, optimal EHR lookback varied by RA duration; an EHR lookback of 3 years was best able to identify recently diagnosed RA cases. Conclusions eMERGE algorithm performance improves with longer RA duration as well as EHR duration up to 10 years, though shorter EHR lookback can improve identification of recently diagnosed RA cases.

Predicting Postthyroidectomy Hypocalcemia: Improving Predictive Ability of Parathyroid Hormone Level

2020 ◽  
Vol 86 (2) ◽  
pp. 121-126 ◽  
Author(s):  
Veljko Strajina ◽  
Benzon M. Dy ◽  
Travis J. Mckenzie ◽  
Geoffrey B. Thompson ◽  
Melanie L. Lyden
Keyword(s):  
Parathyroid Hormone ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Calcium Level ◽  
Predictive Ability ◽  
Postoperative Hypocalcemia ◽  
Total Blood ◽  
Blood Calcium ◽  
Large Patient ◽  
Pth Level

We performed a retrospective study of our large patient cohort aiming to examine the ability to predict postthyroidectomy hypocalcemia. A retrospective review of patients who underwent total or near-total thyroidectomy at our institution between 2008 and 2018 was performed. Postoperative hypocalcemia was defined as Ca level <8.0 mg/dL (reference range: 8.9–10.1 mg/dL) within 30 days of operation. Logistic regression was used to develop models for prediction of the occurrence of postoperative hypocalcemia. Inclusion criteria were met by 1463 patients. Hypocalcemia was documented in 223 patients (15%). Models based on parathyroid hormone (PTH) levels alone had an associated receiver operator characteristic with an areas under the curve (AUC) of 0.79. There was an inverse relationship between time of measurement and PTH levels within the first two hours after thyroidectomy ( P < 0.01). When measured two to six hours after closure, the predictive ability of PTH compared favorably (AUC = 0.82) with either earlier (within the first two hours after closure, AUC = 0.79) or later measurement (6–24 hours after closure, AUC = 0.77). When measured between two and six hours postoperatively, PTH < 19 pg/mL had a sensitivity of 90 per cent and negative predictive value of 96 per cent for postoperative hypocalcemia. The model that included the PTH level, concurrently measured total blood calcium level, and time of measurement had an improved predictive ability with an AUC of 0.87. PTH level of 19 pg/mL measured two to six hours after thyroidectomy had a sensitivity of 90 per cent and a negative predictive value of 96 per cent in our cohort. The model including postoperative PTH level, calcium level, and time of measurement may further improve the ability to predict postthyroidectomy hypocalcemia.

scholarly journals Clinical utility of chromogranin A for the surveillance of succinate dehydrogenase B- and succinate dehydrogenase D-related paraganglioma

2018 ◽  
Vol 56 (1) ◽  
pp. 163-169 ◽  
Author(s):  
Michael JW Thompson ◽  
Venkat Parameswaran ◽  
John R Burgess
Keyword(s):  
Succinate Dehydrogenase ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Chromogranin A ◽  
Population Based ◽  
Tertiary Referral Centre ◽  
Sdhb Mutation ◽  
Cross Sectional ◽  
Pet Ct ◽  
Plasma Metanephrines

Background Patients with mutations of succinate dehydrogenase B (SDHB) and succinate dehydrogenase D (SDHD) are at high risk of paraganglioma necessitating surveillance. Chromogranin A has been proposed as a biochemical marker of paraganglioma. We sought to determine the diagnostic utility of chromogranin A in a population-based SDHx sample. Methods Tasmania is an island state with one tertiary referral centre for endocrine neoplasia. We performed a cross-sectional analysis of all adult SDHB ( n = 52) and SDHD ( n = 10) patients undergoing paraganglioma surveillance between 2011 and 2017. Chromogranin A was referenced against the outcome of paraganglioma surveillance with a minimum of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and plasma metanephrines (metanephrine and normetanephrine). Results Chromogranin A correctly predicted the result of paraganglioma surveillance more often in patients with SDHB compared with those with SDHD (77% vs. 22%, P = 0.003). In the SDHB group, chromogranin A demonstrated a sensitivity of 67% and specificity of 79% compared with 22% and 0% in the SDHD group. Chromogranin A identified one of three PET/CT-visualized SDHB-related paragangliomas with normal plasma metanephrines at the expense of nine false-positive results. A normal chromogranin A demonstrated a negative predictive value of 92% for SDHB-related paraganglioma. In patients with SDHB, plasma normetanephrine and metanephrine offered superior specificity (100%, P = 0.01 and 100%, P < 0.01, respectively) with comparable sensitivity (67%, P = 1.0 and 11%, P = 0.06, respectively) to chromogranin A. Conclusion Chromogranin A does not provide additive benefit to standard surveillance for predicting the presence of SDHB- or SDHD-related paraganglioma, but has a useful negative predictive value when normal in patients with SDHB mutation.

Negative Predictive Value of a Population-based Preschool Vision Screening Program

Ophthalmology ◽  
1992 ◽  
Vol 99 (6) ◽  
pp. 998-1003 ◽  
Author(s):  
Inge De Becker ◽  
Heather J. MacPherson ◽  
G. Robert LaRoche ◽  
Janet Braunstein ◽  
Robin Cottle ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Screening Program ◽  
Population Based ◽  
Vision Screening

scholarly journals Diagnostic performance of p16/Ki-67 dual immunostaining at different number of positive cells in cervical smears in women referred for colposcopy

2021 ◽  
Vol 55 (4) ◽  
pp. 426-432
Author(s):  
Ursula Salobir Gajsek ◽  
Andraz Dovnik ◽  
Iztok Takac ◽  
Urska Ivanus ◽  
Tine Jerman ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Large Scale ◽  
High Sensitivity ◽  
Intraepithelial Neoplasia ◽  
Population Based ◽  
Cervical Cytology ◽  
Published Data ◽  
Ki 67 ◽  
Randomised Controlled

Abstract Background The aim of the study was to evaluate the diagnostic accuracy of p16/Ki-67 dual immunostaining (p16/ Ki-67 DS) in cervical cytology and the number of positive p16/Ki-67 cells to diagnose high grade cervical intraepithelial neoplasia (CIN2+) in colposcopy population. Subjects and methods We performed an analysis on a subset cohort of 174 women enrolled within a large-scale randomised controlled human papillomavirus (HPV) self-sampling project organised as part of the population-based Cervical Cancer Screening Programme ZORA in Slovenia. This subset cohort of patients was invited to the colposcopy clinic, underwent p16/Ki-67 DS cervical cytology and had the number of p16/Ki-67 positive cells determined. Results Among analysed women, 42/174 (24.1%) had histologically confirmed CIN2+. The risk for CIN2+ was increasing with the number of positive cells (p < 0.001). The sensitivity of p16/Ki-67 DS for detection of CIN2+ was 88.1%, specificity was 65.2%, positive predictive value was 44.6% and negative predictive value was 94.5%. Conclusions Dual p16/Ki-67 immunostaining for the detection of CIN2+ has shown high sensitivity and high negative predictive value in our study, which is comparable to available published data. The number of p16/Ki-67 positive cells was significantly associated with the probability of CIN2+ detection. We observed a statistically significant and clinically relevant increase in specificity if the cut-off for a positive test was shifted from one cell to three cells.

scholarly journals Validation of the lingual frenulum protocol for infants

2016 ◽  
pp. 6-14
Author(s):  
Roberta Martinelli ◽  
◽  
Irene Marchesan ◽  
Jose Lauris ◽  
Heitor Honorio ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Construct Validity ◽  
Negative Predictive Value ◽  
Content Validity ◽  
Predictive Value ◽  
Criterion Validity ◽  
Control Group ◽  
Perinatal Complications ◽  
Term Infants ◽  
Sensitivity Specificity

Introduction: In Brazil, the law 13.002/2014 states that all newborns in the country must undergo lingual frenulum assessment before hospital discharge. Objective: To validate the Lingual Frenulum Protocol for Infants. Material and Methods: The study used data from 100 infants assessed at 30 days of life at Santa Therezinha Hospital, in Brotas, SP, Brazil. The LFPI was administered to the 30-day-old infants and all assessments were registered in patient records and videotaped. Live exams, assessments and re-assessments using images of the infants were performed by two examiners experienced in Orofacial Myofunctional Disorders. The study included healthy full-term infants of both genders, who were being breastfed exclusively. Prematurity, perinatal complications, craniofacial anomalies, neurological disorders, and visible genetics syndromes were the exclusion criteria. The validation process included the analysis of content validity, criterion validity, construct validity, reliability, sensitivity, specificity, positive predictive value, and negative predictive value. Results: Concerning content validity, the percentage of agreement was 100%. The criterion validity was measured by comparing the common items of the LFPI and BTAT. The agreement percentage for the analyzed items was 100%. The construct validity was analyzed by comparing the partial and total scores from the assessment of infants with and without lingual frenulum alteration at 30 and 75 days of life. Results demonstrated similarity of scores between the control group and the group that underwent frenotomy. The results from the inter-rater and intra-rater agreement analysis indicated perfect agreement. The values of sensitivity, specificity, positive predictive value, and negative predictive value were 100%. Conclusion: The study concluded that the LFPI was a valid and reliable assessment too that ensures accuracy when diagnosing lingual frenulum alterations within the investigated parameters.

scholarly journals Validity of a 2-item screening tool to identify families at risk for food insecurity in Brazil

2021 ◽  
Vol 37 (6) ◽  
Author(s):  
Ana Poblacion ◽  
Ana Maria Segall-Corrêa ◽  
John Cook ◽  
Jose Augusto de Aguiar Carrazedo Taddei
Keyword(s):  
At Risk ◽  
Food Insecurity ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Convergent Validity ◽  
Screening Tool ◽  
Roc Curves ◽  
Roc Area ◽  
Sensitivity Specificity

This manuscript aimed to develop a brief 2-item screening tool to identify Brazilian households that include families with children at risk for food insecurity. Psychometric analyses including sensitivity, specificity, positive and negative predictive value, accuracy, and ROC curves were used to test combinations of questions to determine the most effective screener to assess households at risk for food insecurity when compared to a gold standard scale. Participants included Brazilian National Survey of Demography and Health on Women and Children (PNDS) surveyed households with a valid Brazilian Food Insecurity Scale (EBIA) response. The sample included 3,920 households representing 11,779,686 households when expanded using PNDS sample weights. With overall prevalence of food insecurity at 21%, a Brazilian 2-item food-insecurity screen showed sensitivity of 79.31%, specificity of 92.95%, positive predictive value of 74.62%, negative predictive value of 94.5% and ROC area 86.13%. This screen also presented high convergent validity for children’s nutrition and health variables when compared with the gold standard, the EBIA full scale. Based on its ability to detect households at risk for food insecurity, a 2-item screening tool is recommended for widespread adoption as a screening measure throughout Brazil, especially when rapid decision-making has been made fundamental, as under the COVID-19 pandemic. This screener can enable providers to accurately identify families at risk for food insecurity and promptly intervene to prevent or ameliorate adverse health and developmental consequences associated with food insecurity and swiftly respond to crises.

scholarly journals Natriuretic peptide referral thresholds and heart failure diagnosis: population-based cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Taylor ◽  
J.M Ordonez-Mena ◽  
S Lay-Flurrie ◽  
C Goyder ◽  
N Jones ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Negative Predictive Value ◽  
Natriuretic Peptide ◽  
Predictive Value ◽  
National Level ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Nice Guideline

Abstract Background Natriuretic peptide (NP) testing is recommended by both the European Society of Cardiology (ESC) and the National Institute for Health and Care Excellence (NICE) for people presenting with symptoms of heart failure (HF) in primary care. However, ESC and NICE guidelines suggest different NP referral thresholds: ESC recommend referral at a lower NP level (BNP≥35pg/ml / NT-proBNP≥125pg/ml) compared to NICE (BNP≥100pg/ml/NT-proBNP≥400pg/ml). Purpose We aimed to evaluate NP test performance for HF diagnosis for ESC and NICE guideline-defined thresholds. Methods Population-based cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink in England between 1st January 2000 and 31st December 2018. Participants were adults aged 45 years and above with a NP result: 74,233 had a BNP and 155,347 had a NT-proBNP measurement. The main outcome measures were diagnostic performance of NP test (sensitivity, specificity, positive predictive value, negative predictive value) by threshold. Results A total of 229,580 patients had a NP test and 21,102 (9.2%) were diagnosed with HF. The ESC NT-proBNP threshold of 125pg/ml had a sensitivity of 94.6% (94.2 to 95.0) and specificity of 50.0% (49.7 to 50.3) compared to sensitivity of 81.7% (81.0 to 82.3) and specificity of 80.3% (80.0 to 80.5) for the NICE NT-proBNP 400pg/ml threshold. For both guidelines, nearly all patients with a NP level below the threshold did not have HF (negative predictive value ESC 98.9% (98.8 to 99.0) and NICE 97.7% (97.6 to 97.8). Similar performance was found for BNP. Conclusions The performance of NP testing is dependent on the guideline-specified threshold for referral. In 100 people with HF, using the NICE threshold would falsely reassure 18 patients, whereas the lower ESC threshold would miss just 5 people but twice as many patients would be referred for diagnostic assessment. The optimal NP threshold for referral for HF diagnosis will depend on the healthcare setting. The trade-off between missing HF cases and overwhelming diagnostic services needs to be determined at a national level. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health Research

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