scholarly journals Retrospective validation of a new volumetric capnography parameter for the exclusion of pulmonary embolism at the emergency department

2018 ◽  
Vol 4 (4) ◽  
pp. 00099-2018
Author(s):  
Timon M. Fabius ◽  
Michiel M.M. Eijsvogel ◽  
Marjolein G.J. Brusse-Keizer ◽  
Olivier M. Sanchez ◽  
Franck Verschuren ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Diagnostic Accuracy ◽  
Roc Curve ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Carbon Dioxide Production ◽  
Pulmonary Angiography ◽  
Volumetric Capnography

Volumetric capnography might be used to exclude pulmonary embolism (PE) without the need for computed tomography pulmonary angiography. In a pilot study, a new parameter (CapNoPE) combining the amount of carbon dioxide exhaled per breath (carbon dioxide production (VCO2)), the slope of phase 3 of the volumetric capnogram (slope 3) and respiratory rate (RR) showed promising diagnostic accuracy (where CapNoPE=(VCO2×slope 3)/RR).To retrospectively validate CapNoPE for the exclusion of PE, the volumetric capnograms of 205 subjects (68 with PE) were analysed, based on a large multicentre dataset of volumetric capnograms from subjects with suspected PE at the emergency department. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve and diagnostic accuracy of the in-pilot established threshold (1.90 Pa·min) were calculated. CapNoPE was 1.56±0.97 Pa·min in subjects with PE versus 2.51±1.67 Pa·min in those without PE (p<0.001). The AUC of the ROC curve was 0.714 (95% CI 0.64–0.79). For the cut-off of ≥1.90 Pa·min, sensitivity was 64.7%, specificity was 59.9%, the negative predictive value was 77.4% and the positive predictive value was 44.4%.The CapNoPE parameter is decreased in patients with PE but its diagnostic accuracy seems too low to use in clinical practice.

Use of a New Monoclonal Antibody-Based Enzyme Immunoassay for Soluble Fibrin to Exclude Pulmonary Embolism

2000 ◽  
Vol 84 (09) ◽  
pp. 474-477 ◽  
Author(s):  
Bernd-Jan Sanson ◽  
Wouter de Monyé ◽  
Jeroen Lijmer ◽  
Menno Huisman ◽  
Harry Büller ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Pulmonary Embolism ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Area Under The Curve ◽  
Study Cohort ◽  
Suspected Pulmonary Embolism ◽  
Soluble Fibrin

SummaryWe prospectively evaluated the diagnostic performance of a new soluble fibrin assay in 303 consecutive patients with suspected pulmonary embolism and examined potentially useful cut-off levels at which this disease can be safely excluded. In addition, the diagnostic accuracy was calculated in the subgroups of in- and outpatients. The ROC curve of the assay in the total study cohort had an area under the curve of 0.69. The cut-off level associated with a sensitivity and negative predictive value of 100% was 20 ng/ml, but the specificity was only 4%. The cut-off level with a sensitivity of 90% was 30 ng/ml, which corresponded with a specificity and negative predictive value of 27% and 86%, respectively. The diagnostic performance was comparable in the subgroups of in- and outpatients. We conclude that the soluble fibrin assay has a low diagnostic accuracy and seems unsuitable as a screening test for the exclusion of pulmonary embolism.

Excluding Pulmonary Embolism with End-tidal Carbon Dioxide: Accuracy, Cost, and Harm Avoidance

2020 ◽  
Vol 42 (12) ◽  
pp. 1022-1030
Author(s):  
Donna Prentice ◽  
Chelsea B. Deroche ◽  
Deidre D. Wipke-Tevis
Keyword(s):  
Carbon Dioxide ◽  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Pulmonary Angiography ◽  
Harm Avoidance ◽  
Diagnostic Process ◽  
Intravenous Contrast ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

A non-randomized single center prospective, descriptive, correlational design was used to determine what end-tidal carbon dioxide (EtCO2) level provided the best sensitivity, specificity, and negative predictive value to exclude pulmonary embolism (PE) diagnosis in hemodynamically stable hospitalized adults ( n = 111). The financial impact and harm avoidance of adding EtCO2 to the PE diagnostic process also were examined. PE diagnosis was determined by computed tomography pulmonary angiography (CTPA). PE prevalence was 18.9%. Mean±SD EtCO2 was lower for PE positive than negative participants (28 ± 7.8 to 33 ± 8.1 mmHg respectively 95% CI: 1.22–8.96; P = .01). For PE exclusion, an EtCO2 cutoff ≥42 mmHg yielded 100% sensitivity, 12.2% specificity, and 100% negative predictive value. For every six inpatients assessed with EtCO2, one could be saved from unnecessary CTPA. Eliminating unnecessary CTPA removes the potential harm associated with radiation and intravenous contrast exposure. Additionally, an EtCO2 cutoff ≥42 mmHg could eliminate ~$88,000/year in healthcare waste at this institution.

scholarly journals The Use of Bedside Ultrasound in the Evaluation of Patients Presenting with Signs and Symptoms of Pulmonary Embolism

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Adarsh N. Patel ◽  
L. Connor Nickels ◽  
F. Eike Flach ◽  
Giuliano De Portu ◽  
Latha Ganti
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Radiation Exposure ◽  
Computerized Tomography ◽  
Signs And Symptoms ◽  
Pregnant Patient ◽  
Poor Quality ◽  
Pulmonary Angiography ◽  
Bedside Ultrasound

Evaluation of patients that present to the emergency department with concerns for the diagnosis of pulmonary embolism can be difficult. Modalities including computerized tomography (CT) of the chest, pulmonary angiography, and ventilation perfusion scans can expose patients to large quantities of radiation especially if the study has to be repeated due to poor quality. This is particularly a concern in the pregnant population that has an increased incidence of pulmonary embolism and may not be able to undergo multiple radiographic studies due to fetal radiation exposure. This paper presents a case of a pregnant patient with signs and symptoms concerning pulmonary embolism. The paper discusses the use of bedside ultrasound in the evaluation of patients with pulmonary embolism.

Abstract 210: Effects of Indication for Veno-Arterial Extracorporeal Membrane Oxygenation on Predictive Value of Save Score

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Marinos Kosmopoulos ◽  
Jason A Bartos ◽  
Demetris Yannopoulos
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Roc Curve ◽  
Predictive Value ◽  
Prediction Models ◽  
External Validation ◽  
Area Under The Curve ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Membrane Oxygenation ◽  
Survival Estimation ◽  
Va Ecmo

Introduction: Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) has emerged as a prominent tool for management of patients with Inability to Wean Off Cardiopulmonary Bypass (IWOCB), extracorporeal cardiopulmonary resuscitation (eCPR) or refractory cardiogenic shock (RCS). The high mortality that is still associated with these diseases urges for the development of reliable prediction models for mortality after cannulation. Survival After VA ECMO (SAVE) Score consists one of the most widely used prediction tools and the only model with external validation. However, its predictive value is still under debate. Hypothesis: Whether VA ECMO indication affects the predictive value of SAVE Score. Methods: 317 patients treated with VA ECMO in a quaternary center (n= 52 for IWOCB, n=179 for eCPR and n=86 for RCS) were retrospectively assessed for differences in SAVE Score and their primary outcomes. The Receiver Operating Characteristic (ROC) curve for SAVE Score and mortality was calculated separately for each VA ECMO indication. Results: The three groups had significant differences in SAVE Score (p<0.01) without significant differences in mortality (p=0.176). ROC Curve calculation indicated significant differences in predictive value of SAVE Score for survival among its different indications. (Area Under the Curve= 81.69% for IWOCB, 53.79% for eCPR and 69.46% for RCS). Conclusion: VA ECMO indication markedly affects the predictive value of SAVE Score. Prediction of primary outcome in IWOCB patients was reliable. On the contrary, routine application for survival estimation in eCPR patients is not supported from our results.

Diagnostic accuracy of IGF-1 for screening growth hormone deficiency: a prospective, single-center, diagnostic accuracy study

2021 ◽  
Author(s):  
Hideyuki Iwayama ◽  
Sachiko Kitagawa ◽  
Jyun Sada ◽  
Ryosuke Miyamoto ◽  
Tomohito Hayakawa ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Diagnostic Accuracy ◽  
Growth Hormone Deficiency ◽  
Predictive Value ◽  
Screening Test ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Hormone Deficiency ◽  
Height Velocity

Abstract Purpose We evaluated the diagnostic accuracy of insulin-like growth factor-1 (IGF-1) for screening growth hormone deficiency (GHD) to determine the usefulness of IGF-1 as a screening test. Methods On 298 consecutive children who had short stature or decreased height velocity, we measured IGF-1 levels and performed growth hormone (GH) secretion test using clonidine, arginine, and, in cases with different results of the two tests, L-dopa. Patients with congenital abnormalities were excluded. GHD was defined as peak GH ≤ 6.0 ng/mL in the two tests. Results We identified 60 and 238 patients with and without GHD, respectively. The mean IGF-1 (SD) was not significantly different between the GHD and non-GHD groups (p = 0.23). Receiver operating characteristic curve analysis demonstrated the best diagnostic accuracy at an IGF-1 cutoff of −1.493 SD, with sensitivity of 0.685, specificity of 0.417, positive predictive value of 0.25, negative predictive value of 0.823, and area under the curve of 0.517. Spearman’s rank correlation coefficient showed that IGF-1 (SD) was weakly correlated with age, bone age, height velocity before examination, weight (SD), and BMI (SD) and very weakly correlated with height (SD), target height (SD), and maximum GH peak. Conclusion IGF-1 level had poor diagnostic accuracy as a screening test for GHD. Correlation analysis revealed that none of the items increased the diagnostic power of IGF-1. Therefore, IGF-1 should not be used alone in the screening of GHD. A predictive biomarker for GHD should be developed in the future.

scholarly journals The role of red cell distribution width in the differential diagnosis of iron deficiency anemia and non-transfusion dependent thalassemia patients

2018 ◽  
Vol 10 (3) ◽  
Author(s):  
Pokpong Piriyakhuntorn ◽  
Adisak Tantiworawit ◽  
Thanawat Rattanathammethee ◽  
Chatree Chai-Adisaksopha ◽  
Ekarat Rattarittamrong ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Microcytic Anemia ◽  
Deficiency Anemia ◽  
Operating Characteristics ◽  
Training Set ◽  
Distribution Width ◽  
Validation Set ◽  
Sensitivity Specificity

This study aims to find the cut-off value and diagnostic accuracy of the use of RDW as initial investigation in enabling the differentiation between IDA and NTDT patients. Patients with microcytic anemia were enrolled in the training set and used to plot a receiving operating characteristics (ROC) curve to obtain the cut-off value of RDW. A second set of patients were included in the validation set and used to analyze the diagnostic accuracy. We recruited 94 IDA and 64 NTDT patients into the training set. The area under the curve of the ROC in the training set was 0.803. The best cut-off value of RDW in the diagnosis of NTDT was 21.0% with a sensitivity and specificity of 81.3% and 55.3% respectively. In the validation set, there were 34 IDA and 58 NTDT patients using the cut-off value of >21.0% to validate. The sensitivity, specificity, positive predictive value and negative predictive value were 84.5%, 70.6%, 83.1% and 72.7% respectively. We can therefore conclude that RDW >21.0% is useful in differentiating between IDA and NTDT patients with high diagnostic accuracy

Corrigendum: Volumetric capnography in the exclusion of pulmonary embolism at the emergency department: a pilot study (2016 J. Breath Res. 10 046016)

2019 ◽  
Vol 13 (4) ◽  
pp. 049501
Author(s):  
Timon M Fabius ◽  
Michiel M Eijsvogel ◽  
Ivo van der Lee ◽  
Marjolein G J Brusse-Keizer ◽  
Frans H de Jongh
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Pilot Study ◽  
Volumetric Capnography

Prospective Study of the Diagnostic Accuracy of the Simplify D-dimer Assay for Pulmonary Embolism in Emergency Department Patients

CHEST Journal ◽  
2006 ◽  
Vol 129 (6) ◽  
pp. 1417-1423 ◽  
Author(s):  
Jeffrey A. Kline ◽  
Michael S. Runyon ◽  
William B. Webb ◽  
Alan E. Jones ◽  
Alice M. Mitchell
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Diagnostic Accuracy ◽  
Prospective Study ◽  
Emergency Department Patients ◽  
D Dimer

Volumetric capnography in the exclusion of pulmonary embolism at the emergency department: a pilot study

2016 ◽  
Vol 10 (4) ◽  
pp. 046016 ◽  
Author(s):  
Timon M Fabius ◽  
Michiel M Eijsvogel ◽  
Ivo van der Lee ◽  
Marjolein G J Brusse-Keizer ◽  
Frans H de Jongh
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Pilot Study ◽  
Volumetric Capnography

scholarly journals Evaluation of quantitative fFn test in predicting the risk of preterm birth

2017 ◽  
Vol 45 (1) ◽  
Author(s):  
Michela Centra ◽  
Giuliana Coata ◽  
Elena Picchiassi ◽  
Luisa Alfonsi ◽  
Samanta Meniconi ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Diagnostic Accuracy ◽  
Roc Curve ◽  
Predictive Value ◽  
Preterm Labour ◽  
Signs And Symptoms ◽  
Singleton Pregnancy ◽  
Fetal Fibronectin ◽  
Prediction Risk ◽  
Risk Categories

AbstractObjective:To evaluate diagnostic accuracy of quantitative fetal fibronectin (qfFN) test in predicting preterm birth (PTB) risk <34 weeks’ gestation or within 14 days from testing. We explored the predictive potential of the test in five-predefined PTB risk categories based on predefined qfFN thresholds (<10, 10–49, 50–199, 200–499 and ≥500 ng/mL).Methods:Measurement of cervicovaginal qfFN with Rapid fFN 10Q System (Hologic) in 126 women with singleton pregnancy (23–33 weeks’ gestation) reporting signs and symptoms indicative of preterm labour (PTL).Results:For PTB prediction risk <34 weeks’ gestation, sensitivity decreased from 100% to 41.7% and specificity increased from 0% to 99.1% with increasing fFN thresholds. Positive predictive value (PPV) increased from 9.5% to 83.3% with increasing qfFN thresholds, while negative predictive value (NPV) was higher than 90% among the fFN-predefined categories. Diagnostic accuracy results showed an area under a receiving operator characteristic (ROC) curve of 84.5% (95% CI, 0.770–0.903). For delivery prediction within 14 days from the testing, sensitivity decreased from 100% to 42.8% and specificity increased from 0% to 100% with increasing fFN thresholds. Diagnostic accuracy determined by the ROC curve was 66.1% (95% CI, 0.330–0.902).Conclusions:The QfFN thresholds of tests are a useful tool to distinguish pregnant women for PTB prediction risk <34 weeks’ gestation.

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