A diagnostic tool for people with lumbar instability: a criterion-related validity study

Abstract Background Several clinical tests used to identify patients with lumbar instability have reported diagnostic accuracy in separate studies with conflicting results. To augment the diagnostic process, tests that are better able to identify lumbar instability suitable for use in the clinical setting are required. The aim of this study was to identify the probability to diagnose patients with lumbar instability, using x-ray imaging as the reference standard. Methods This study was a cross-sectional, diagnostic validity study. One hundred forty participants with chronic low back pain underwent an x-ray assessment and 14 clinical examinations. Data were analysed using multivariate regression methods to determine which clinical tests were most diagnostic for lumbar instability when they were applied together. Results Eighteen (12.85%) participants had radiological lumbar instability. Three clinical tests i) interspinous gap change during flexion-extension, ii) passive accessory intervertebral movement tests, iii) posterior shear test demonstrated an ability to diagnose lumbar instability of 67% when they were all positive. At this probability threshold, sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (−LR) were 5.56, 99.18%, 6.78, and 0.95. Conclusions These 3 clinical tests could be useful in identifying patients with lumbar instability in the general community. These three tests are simple to perform by physical therapists, reliable to use in a clinical setting, and safe for patients. We recommend physical therapists use these three tests to assess patients who are suspected of having lumbar instability, in the absence of an x-ray assessment, to receive appropriate targeted intervention or referral for further investigation. Trial registration Thai Clinial Trial Registry (TCTR 20180820001; 19th August 2018).

Download Full-text

A New Evaluation Method for Lumbar Spinal Instability: Passive Lumbar Extension Test

Physical Therapy ◽

10.2522/ptj.20050281 ◽

2006 ◽

Vol 86 (12) ◽

pp. 1661-1667 ◽

Cited By ~ 38

Author(s):

Yuichi Kasai ◽

Koichiro Morishita ◽

Eiji Kawakita ◽

Tetsushi Kondo ◽

Atsumasa Uchida

Keyword(s):

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Evaluation Method ◽

Positive Likelihood Ratio ◽

Spinal Instability ◽

Predictive Values ◽

Flexion Extension ◽

Lumbar Extension ◽

Lumbar Spinal ◽

Sensitivity Specificity

Abstract Background and PurposeAlthough many studies have described clinical examination measures for the diagnosis of lumbar spinal instability, few of them have investigated the sensitivity and specificity of the measures that were used. The authors devised a passive lumbar extension (PLE) test for assessing lumbar spinal instability. The purpose of this study was to investigate the sensitivity, specificity, and positive likelihood ratio of this test. Subjects and Methods. The PLE test as well as the instability catch sign, painful catch sign, and apprehension sign tests were done for 122 subjects with lumbar degenerative diseases. The subjects were divided into 2 groups—instability positive and instability negative—on the basis of findings on flexion-extension films of the lumbar spine. The sensitivity, specificity, predictive values, and positive likelihood ratio of each test were investigated. Results. The sensitivity and specificity of the PLE test were 84.2% and 90.4%, respectively. These values were higher than those of other signs. The positive likelihood ratio of the PLE test was 8.84 (95% confidence interval=4.51–17.33). Discussion and Conclusion. The PLE test is an effective method for examining patients for lumbar spinal instability and can be performed easily in an outpatient clinic.

Download Full-text

The Diagnostic Value of the Ulnocarpal Stress Test for Differentiating the Symptomatic Triangular Fibrocartilage Complex Tear from the Incidental Tear

Archives of Hand and Microsurgery ◽

10.12790/ahm.20.0066 ◽

2020 ◽

Vol 25 (4) ◽

pp. 259-266

Author(s):

Cheol-U Kim ◽

Dong Hyun Kim ◽

Bong Cheol Kwon

Keyword(s):

Likelihood Ratio ◽

Predictive Value ◽

Stress Test ◽

Positive Likelihood Ratio ◽

Diagnostic Value ◽

Triangular Fibrocartilage Complex ◽

Diagnostic Process ◽

Symptom Improvement ◽

Control Group ◽

Triangular Fibrocartilage

Purpose: The purpose of this study was to determine the diagnostic value of the ulnocarpal stress test (UCST) for differentiating the symptomatic triangular fibrocartilage complex (TFCC) tear from the incidental tear.Methods: From January 2013 to May 2020, a study was performed on 109 patients who underwent wrist arthroscopy and showed TFCC tear. Patients who had ulnar-sided wrist pain along with TFCC tear, and showed postoperative symptom improvement, and those with other lesions excluded were defined as symptomatic tear (experimental group) and the rest were defined as asymptomatic tear (control group). Diagnostic values of the UCST for differentiating the symptomatic TFCC tear from the incidental tear were calculated.Results: The UCST showed a sensitivity of 54%, a specificity of 95%, a positive predictive value of 98%, a negative predictive value of 31%, a positive likelihood ratio of 10.34, a negative likelihood ratio of 0.48, and an overall diagnostic accuracy of 61%. Conclusion: The UCST showed limited diagnostic value for symptomatic TFCC tear. Therefore, this test needs to be regarded as a part of diagnostic process and their results should be interpreted in the context of other relevant clinical information before reaching the diagnosis of symptomatic TFCC tear.

Download Full-text

The relative incidence of cardiogenic and septic shock in neonates

Paediatrics & Child Health ◽

10.1093/pch/pxz078 ◽

2019 ◽

Vol 25 (6) ◽

pp. 372-377

Author(s):

Ka Hong Chan ◽

Shubhayan Sanatani ◽

James E Potts ◽

Kevin C Harris

Keyword(s):

Septic Shock ◽

Cardiogenic Shock ◽

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Term Neonates ◽

X Ray ◽

Relative Incidence ◽

History Of ◽

Chest X Ray

Abstract Objective To evaluate the relative incidence of cardiogenic and septic shock in term neonates and identify findings that help differentiate the two entities. Study Design We conducted a retrospective chart review of term neonates presenting to British Columbia Children’s Hospital (BCCH) with decompensated shock of an undiagnosed etiology between January 1, 2008 and January 1, 2013. Charts were reviewed to determine the underlying diagnoses of all neonates meeting our inclusion criteria. Patients were categorized as having septic, cardiogenic, or other etiologies of shock. We then evaluated potential demographic, clinical, and biochemical parameters that could help differentiate between septic and cardiogenic shock. Results Cardiogenic shock was more common than septic shock (relative risk=1.53). A history of cyanosis was suggestive of cardiogenic shock (positive likelihood ratio, LR+=3.2 and negative likelihood ratio, LR−=0.4). Presence of a murmur or gallop (LR+=5.4, LR−=0.3), or decreased femoral pulses (LR+=5.1, LR−=0.5) on physical exam were also suggestive of cardiogenic shock as was cardiomegaly on chest x-ray (LR+=4.9, LR−=0.5). Notably, temperature instability (LR+=0.7, LR−=1.8) and white blood cell count elevation or depression (LR+=0.8, LR−=1.1) were all poor predictors of septic shock. Conclusion Cardiogenic shock is a more common cause of decompensated shock than septic shock. A history of cyanosis, murmur or gallop, or decreased femoral pulses on exam and cardiomegaly on chest x-ray are useful indicators of cardiogenic shock. In evaluating the neonate with decompensated shock, early consideration for Cardiology consultation and interventions to treat the underlying condition is warranted.

Download Full-text

Clinical Utility of Traditional and New Tests in the Diagnosis of Biceps Tendon Injuries and Superior Labrum Anterior and Posterior Lesions in the Shoulder

The American Journal of Sports Medicine ◽

10.1177/0363546509332505 ◽

2009 ◽

Vol 37 (9) ◽

pp. 1840-1847 ◽

Cited By ~ 119

Author(s):

W. Ben Kibler ◽

Aaron D. Sciascia ◽

Peter Hester ◽

David Dome ◽

Cale Jacobs

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Likelihood Ratio ◽

Clinical Examination ◽

Logistic Regression Analysis ◽

Clinical Utility ◽

Positive Likelihood Ratio ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Clinical Tests

Background Clinical tests are a key element in diagnosing shoulder lesions. Purpose This study examined the clinical utility of traditional and new examination tests, the upper cut for biceps injuries, and the modified dynamic labral shear for superior glenoid labral lesions. Study Design Cohort study (Diagnosis); Level of evidence, 2. Methods A total of 325 consecutive patients who were seen for shoulder pain underwent a standardized clinical testing battery. Six clinical tests that have been previously reported in the literature (Yergason's, Speed's, bear hug, belly press, O'Brien's, and anterior slide) and 2 new examination tests (upper cut and modified dynamic labral shear) were performed. Clinical examination findings were correlated with findings in those who came to surgery (101 patients). Sensitivity, specificity, accuracy, positive/ negative predictive value, and positive/negative likelihood ratio were calculated for each test. A binary logistic regression analysis was used to determine which tests produced the most significant findings. Results For biceps disease, the bear hug and upper cut were most sensitive (0.79 and 0.73, respectively), whereas the belly press and Speed's test were most specific (0.85 and 0.81, respectively). The upper cut was most accurate (0.77) and produced the highest positive likelihood ratio (3.38). For labral injury, the modified dynamic labral shear demonstrated sensitivity of 0.72, specificity of 0.98, accuracy of 0.84, and a positive likelihood ratio of 31.57. A binary logistic regression analysis revealed that the combination of the upper cut and Speed's tests were significantly better at detecting biceps lesions (P = .021, R2 = .400) than other tests, whereas labral lesions were best identified by combination of the modified dynamic labral shear and O'Brien's maneuvers (P = .045, R2 = .641). Conclusion The new tests are helpful additions to the clinical examination for shoulder injury. The modified dynamic labral shear test demonstrates high scores for clinical utility and exhibits a high likelihood ratio, indicating a significant probability of affecting the clinical decision, which should moderately or significantly improve the diagnostic conclusion and allow the clinician to be more efficient in making an accurate diagnosis.

Download Full-text

Validity-Study of Commercial Semiconductor with TO-18 Package for Space Application by PIND Test

ISTFA 2013: Conference Proceedings from the 39th International Symposium for Testing and Failure Analysis ◽

10.31399/asm.cp.istfa2013p0523 ◽

2013 ◽

Author(s):

Yusuke Nakatake ◽

Makoto Okabe ◽

Shota Sato

Keyword(s):

Industrial Applications ◽

Validity Study ◽

Space Application ◽

Noise Detection ◽

Foreign Material ◽

Contamination Control ◽

X Ray ◽

Impact Noise ◽

Report Analysis ◽

Foreign Materials

Abstract In this paper, we carried out PIND (Particle Impact Noise Detection) test and X-ray inspection of a transistor in a TO-18 package for commercial and industrial applications. From our evaluation results, we explain the validity of the PIND test by comparing PIND test and X-ray inspection results. We make clear that PIND test is able to detect internal foreign material that may be transparent to X-ray inspection. In addition, we report analysis results of internal foreign materials from defective devices. This matter suggests that a problem is contamination control in the manufacturing process, most likely the sealing process.

Download Full-text

The Potential Diagnostic Accuracy of Circulating MicroRNAs for Leukemia: A Meta-Analysis

Technology in Cancer Research & Treatment ◽

10.1177/15330338211011958 ◽

2021 ◽

Vol 20 ◽

pp. 153303382110119

Author(s):

Wen-Ting Zhang ◽

Guo-Xun Zhang ◽

Shuai-Shuai Gao

Keyword(s):

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Subgroup Analysis ◽

Meta Analysis ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Circulating Micrornas ◽

Sensitivity Specificity

Background: Leukemia is a common malignant disease in the human blood system. Many researchers have proposed circulating microRNAs as biomarkers for the diagnosis of leukemia. We conducted a meta-analysis to evaluate the diagnostic accuracy of circulating miRNAs in the diagnosis of leukemia. Methods: A comprehensive literature search (updated to October 13, 2020) in PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang database and China National Knowledge Infrastructure (CNKI) was performed to identify eligible studies. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) for diagnosing leukemia were pooled for both overall and subgroup analysis. The meta-regression and subgroup analysis were performed to explore heterogeneity and Deeks’ funnel plot was used to assess publication bias. Results: 49 studies from 22 publications with a total of 3,489 leukemia patients and 2,756 healthy controls were included in this meta-analysis. The overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the curve were 0.83, 0.92, 10.8, 0.18, 59 and 0.94, respectively. Subgroup analysis shows that the microRNA clusters of plasma type could carry out a better diagnostic accuracy of leukemia patients. In addition, publication bias was not found. Conclusions: Circulating microRNAs can be used as a promising noninvasive biomarker in the early diagnosis of leukemia.

Download Full-text

The value of glycosylated hemoglobin in the diagnosis of diabetic retinopathy: a systematic review and Meta-analysis

BMC Endocrine Disorders ◽

10.1186/s12902-021-00737-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bo Zhang ◽

Bingjie Zhang ◽

Zhulin Zhou ◽

Yutong Guo ◽

Dan Wang

Keyword(s):

Diabetic Retinopathy ◽

Likelihood Ratio ◽

Roc Curve ◽

Meta Analysis ◽

Glycosylated Hemoglobin ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Biomedical Literature ◽

Cochrane Library ◽

Clinical Value

AbstractObjectiveGlycosylated hemoglobin (HbA1c) has obvious clinical value in the diagnosis of diabetes, but the conclusions on the diagnostic value of diabetic retinopathy (DR) are not consistent. This study aims to comprehensively evaluate the accuracy of glycosylated hemoglobin in the diagnosis of diabetic retinopathy through the meta-analysis of diagnostic tests.MethodsCochrane Library, Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), China Wanfang Database, Chinese Biomedical Literature Database (CBM) were searched until November, 2020. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the quality of the included studies. The pooled sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR) and areas under the receiver operating characteristic (ROC) curve were calculated by Stata 15.0 software.ResultsAfter screening, 18 high-quality papers were included. The results of meta-analysis showed that the combined DOR = 18.19 (95% CI: 10.99–30.11), the sensitivity= 0.81 (95% CI): 0.75 ~ 0.87), specificity = 0.81 (95%CI: 0.72 ~ 0.87), +LR = 4.2 (95%CI: 2.95 ~ 6.00), −LR = 0.23 (95%CI: 0.17 ~ 0.31), and the area under the Summary ROC curve was 0.88 (95%CI: 0.85 ~ 0.90).ConclusionThe overall accuracy of HbA1cC forin diagnosing diabetic retinopathy is good. As it is more stable than blood sugar and is not affected by meals, it may be a suitable indicator for diabetic retinopathy.

Download Full-text

Optimal Range of Fecal Calprotectin for Predicting Mucosal Healing in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Visceral Medicine ◽

10.1159/000514196 ◽

2021 ◽

pp. 1-11

Author(s):

Bing-Jie Xiang ◽

Min Jiang ◽

Ming-Jun Sun ◽

Cong Dai

Keyword(s):

Inflammatory Bowel Disease ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Bowel Disease ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Inflammatory Bowel

Objective: Fecal calprotectin (FC) is a promising marker for assessment of inflammatory bowel disease (IBD) activity. However, the utility of FC for predicting mucosal healing (MH) of IBD patients has yet to be clearly demonstrated. The objective of our study was to perform a meta-analysis evaluating the diagnostic accuracy of FC in predicting MH of IBD patients. Methods: We systematically searched the databases for studies from inception to April 2020 that evaluated MH in IBD. The methodological quality of each study was assessed according to the Quality Assessment of Diagnostic Accuracy Studies checklist. The extracted data were pooled using a summary receiver operating characteristic curve model. Random-effects model was used to summarize the diagnostic odds ratio, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Results: Sixteen studies comprising 1,682 ulcerative colitis (UC) patients and 4 studies comprising 221 Crohn’s disease (CD) patients were included. The best performance of FC for predicting MH in UC was at cut-off range of 60–75 μg/g with area under the curve (AUC) of 0.88 and pooled sensitivity and specificity of 0.87 and 0.79, respectively. The pooled sensitivity and specificity values of cutoff range 180–250 μg/g for predicting MH in CD were 0.67 and 0.76, respectively. The AUC of 0.79 also revealed improved discrimination for identifying MH in CD with FC concentration. Conclusion: Our meta-analysis has found that FC is a simple, reliable noninvasive marker for predicting MH in IBD patients. FC cutoff range 60–75 μg/g appears to have the best overall accuracy in UC patients.

Download Full-text

Circulating tumour DNA methylation in hepatocellular carcinoma diagnosis using digital droplet PCR

Journal of International Medical Research ◽

10.1177/0300060521992962 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199296

Author(s):

Juan Wang ◽

Liu Yang ◽

Yanjun Diao ◽

Jiayun Liu ◽

Jinjie Li ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Dna Methylation ◽

Likelihood Ratio ◽

Predictive Value ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Control Group ◽

Control Subjects ◽

Droplet Pcr ◽

Healthy Control

Objective To evaluate the performance of a DNA methylation-based digital droplet polymerase chain reaction (ddPCR) assay to detect aberrant DNA methylation in cell-free DNA (cfDNA) and to determine its application in the detection of hepatocellular carcinoma (HCC). Methods The present study recruited patients with liver-related diseases and healthy control subjects. Blood samples were used for the extraction of cfDNA, which was then bisulfite converted and the extent of DNA methylation quantified using a ddPCR platform. Results A total of 97 patients with HCC, 80 healthy control subjects and 46 patients with chronic hepatitis B/C virus infection were enrolled in the study. The level of cfDNA in the HCC group was significantly higher than that in the healthy control group. For the detection of HCC, based on a cut-off value of 15.7% for the cfDNA methylation ratio, the sensitivity and specificity were 78.57% and 89.38%, respectively. The diagnostic accuracy was 85.27%, the positive predictive value was 81.91% and the negative predictive value was 87.20%. The positive likelihood ratio of 15.7% in HCC diagnosis was 7.40, while the negative likelihood ratio was 0.24. Conclusions A sensitive methylation-based assay might serve as a liquid biopsy test for diagnosing HCC.

Download Full-text

Test characteristics of history, examination and investigations in the evaluation for septic arthritis in the child presenting with acute non-traumatic limp. A systematic review

BMJ Open ◽

10.1136/bmjopen-2020-038088 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038088

Author(s):

Jacky Tu ◽

Peter Gowdie ◽

Julian Cassar ◽

Simon Craig

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Septic Arthritis ◽

Quality Assessment ◽

Likelihood Ratio ◽

Risk Prediction ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Prediction Tools ◽

Clinical Risk

BackgroundSeptic arthritis is an uncommon but potentially significant diagnosis to be considered when a child presents to the emergency department (ED) with non-traumatic limp. Our objective was to determine the diagnostic accuracy of clinical findings (history and examination) and investigation results (pathology tests and imaging) for the diagnosis of septic arthritis among children presenting with acute non-traumatic limp to the ED.MethodsSystematic review of the literature published between 1966 and June 2019 on MEDLINE and EMBASE databases. Studies were included if they evaluated children presenting with lower limb complaints and evaluated diagnostic performance of items from history, physical examination, laboratory testing or radiological examination. Data were independently extracted by two authors, and quality assessment was performed using the Quality Assessment Tool for Diagnostic Accuracy Studies 2 tool.Results18 studies were identified, and included 2672 children (560 with a final diagnosis of septic arthritis). There was substantial heterogeneity in inclusion criteria, study setting, definitions of specific variables and the gold standard used to confirm septic arthritis. Clinical and investigation findings were reported using varying definitions and cut-offs, and applied to differing study populations. Spectrum bias and poor-to-moderate study design quality limit their applicability to the ED setting.Single studies suggest that the presence of joint tenderness (n=189; positive likelihood ratio 11.4 (95% CI 5.9 to 22.0); negative likelihood ratio 0.2 (95% CI 0.0 to 1.2)) and joint effusion on ultrasound (n=127; positive likelihood ratio 8.4 (95% CI 4.1 to 17.1); negative likelihood ratio 0.2 (95% CI 0.1 to 0.3)) appear to be useful. Two promising clinical risk prediction tools were identified, however, their performance was notably lower when tested in external validation studies.DiscussionDifferentiating children with septic arthritis from non-emergent disorders of non-traumatic limp remains a key diagnostic challenge for emergency physicians. There is a need for prospectively derived and validated ED-based clinical risk prediction tools.

Download Full-text