scholarly journals Performance evaluation of RDT, light microscopy, and PET-PCR for detecting Plasmodium falciparum malaria infections in the 2018 Zambia National Malaria Indicator Survey

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mulenga C. Mwenda ◽  
Abebe A. Fola ◽  
Ilinca I. Ciubotariu ◽  
Conceptor Mulube ◽  
Brenda Mambwe ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Diagnostic Accuracy ◽  
Light Microscopy ◽  
Transmission Spectrum ◽  
Gold Standard ◽  
Diagnostic Performance ◽  
Diagnostic Methods ◽  
High Rate ◽  
Predictive Values ◽  
Malaria Indicator Survey

Abstract Background Zambia continues to advance on the path to elimination with significant reductions in malaria morbidity and mortality. Crucial components that have contributed to progress thus far and are necessary for achieving the national malaria elimination goals include properly identifying and treating all malaria cases through accurate diagnosis. This study sought to compare and assess the diagnostic performance of Rapid Diagnostic Tests (RDT) and Light Microscopy (LM) with photo-induced electron transfer polymerase chain reaction (PET-PCR) as the gold standard using 2018 Malaria Indicator Survey (MIS) data across Zambia to better understand diagnostic accuracy metrics and how these vary across a transmission gradient. Methods Cross-sectional samples collected in a nationally representative survey from 7 provinces in Zambia were tested for the presence of malaria parasites by light microscopy (LM), rapid diagnostic test (RDT) and the gold standard PET-PCR. Diagnostic performance was assessed including sensitivity, specificity, negative- and positive-predictive values across a wide malaria transmission spectrum. Diagnostic accuracy metrics were measured, and statistically significant differences were calculated between test methods for different outcome variables. Results From the individuals included in the MIS, the overall prevalence of Plasmodium falciparum malaria was 32.9% by RDT, 19.4% by LM, and 23.2% by PET-PCR. Herein, RDT and LM diagnostic performance was compared against gold standard PET-PCR with LM displaying a higher diagnostic accuracy than RDTs (91.3% vs. 84.6% respectively) across the transmission spectrum in Zambia. However, the performance of both diagnostics was significantly reduced in low parasitaemia samples. Consistent with previous studies, RDT diagnostic accuracy was predominantly affected by a high rate of false positives. Conclusions RDTs and LM both perform well across a range of transmission intensities within their respective target applications, i.e., in the community, for the former, where ease of use and speed of result is critical, and at the health facility, for the latter, where accuracy is prioritized. However, the performance of both diagnostic methods is adversely affected by low parasitaemia infections. As Zambia moves towards elimination more sensitive tools may be required to identify the last cases.

scholarly journals Performance Evaluation of RDT, Light Microscopy, and PET-PCR for Detecting P. Falciparum Malaria Infections in the 2018 Zambia National Malaria Indicator Survey

2021 ◽  
Author(s):  
Mulenga C. Mwenda ◽  
Abebe A. Fola ◽  
Ilinca I. Ciubotariu ◽  
Conceptor Mulube ◽  
Brenda Mambwe ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Light Microscopy ◽  
Transmission Spectrum ◽  
Gold Standard ◽  
Diagnostic Performance ◽  
False Positive Rate ◽  
Test Methods ◽  
High Rate ◽  
Predictive Values ◽  
Malaria Indicator Survey

Abstract BackgroundZambia continues to advance on the path to elimination with significant reductions in malaria morbidity and mortality. Crucial components that have contributed to progress thus far and are necessary for achieving the national malaria elimination goals include properly identifying and treating all malaria cases through accurate diagnosis. This study sought to compare and assess the diagnostic performance of RDTs and LM with PET-PCR as the gold standard using 2018 MIS data across Zambia to better understand diagnostic accuracy metrics and how these vary across a transmission gradient. MethodsCross-sectional samples collected in a nationally representative survey from 7 provinces in Zambia were tested for the presence of malaria parasites by light microscopy (LM), rapid diagnostic test (RDT) and the gold standard PET-PCR. Diagnostic performance was assessed including sensitivity, specificity, negative- and positive-predictive values across a wide malaria transmission spectrum. Diagnostic accuracy metrics were measured, and statistically significant differences were calculated between test methods for different outcome variables. ResultsFrom the individuals included in the MIS, the overall prevalence of P. falciparum malaria was 32.9% by RDT, 19.4% by LM, and 23.2% by PET-PCR. Herein, we compared RDT and LM diagnostic performance against gold standard PET-PCR and found that LM had higher diagnostic accuracy than RDTs (91.3% vs 84.6% respectively) across the transmission spectrum in Zambia. However, we found that the performance of both diagnostics was significantly reduced in low parasitemia samples. Consistent with previous studies, RDT diagnostic accuracy was predominantly affected by a high rate of false positives.ConclusionWhile LM performance is overall superior to RDTs, the additional requirements for its implementation such as high-quality staining, microscopes, and additional manpower, means that its application will remain at the health facility level. In contrast, while RDTs overestimate prevalence as they have a higher false positive rate, their ability to be rapidly deployed makes them an excellent community level tool. Overall, we found that the performance of both diagnostics was acceptable, and their use should be continued.

Accuracy of MRI in the Differential Diagnosis of Wilms Tumor

2021 ◽  
Vol 15 (8) ◽  
pp. 2057-2059
Author(s):  
Maham Ashraf ◽  
Aysha Anjum ◽  
Eisha Tahir ◽  
Amber Goraya ◽  
Rabia Aqeel
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Accuracy ◽  
Gold Standard ◽  
Wilms Tumor ◽  
Correct Diagnosis ◽  
Renal Tumors ◽  
Common Finding ◽  
Predictive Values ◽  
Female Ratio ◽  
Male Predominance

Background & Objective: Renal tumors are a common finding in diagnostic imaging; these lesions usually are solid or cystic, benign or malignant, and the correct diagnosis may be difficult. The current study aims at to determine the diagnostic accuracy of magnetic resonance imaging for the diagnosis of Wilms tumor taking histopathology as gold standard. Methodology: This cross-sectional study was carried at the Department of Radiology, The Children’s Hospital & Institute of Child Health Lahore over 6 months from March 2019 to September 2019. The study involved 125 children of both genders aged between 2 years to 14 years presenting with a neoplastic mass in the retroperitoneum on ultrasound abdomen during initial workup. These children were assessed on MRI for the diagnosis of Wilms tumor. Later the diagnosis was confirmed on histopathology which was taken as gold standard and the diagnosis of MRI was judged accordingly as true/false and positive/negative. A written informed consent was obtained from every patient. Results: The mean age of the children was 5.8±3.9 years having a male predominance with male to female ratio of 1.8:1. Wilms tumor was suspected in 13 (10.4%) children on MRI. The diagnosis of Wilms tumor was confirmed in 13 (10.4%) children on histopathology. MRI was found to be 76.9% sensitive, 97.3% specific and 95.2% accurate with positive and negative predictive values of 76.9% and 97.3% respectively. Conclusion: In the present study, MRI was found to be 95.2% accurate in the differential diagnosis of Wilms tumor in children presenting with retroperitoneal mass which along with its non-invasive and radiation free nature advocates the preferred use of MRI in the diagnostic evaluation of such children in future oncologic practice. Keywords: Retroperitoneal Tumor, Wilms Tumor, MRI, Diagnostic Accuracy

scholarly journals Optimization of Approaches for Rehabilitation of Adentia Patients Using Modern Clinical Diagnostic Methods

2021 ◽  
Vol 7 (9) ◽  
pp. 323-330
Author(s):  
M. Smanaliev ◽  
G. Yuldasheva ◽  
I. Yuldashev
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Gold Standard ◽  
Titanium Implants ◽  
Diagnostic Methods ◽  
Cone Beam ◽  
Dental Clinics ◽  
Dental Implantation ◽  
Chewing Efficiency ◽  
Biochemical Studies

After determining the need for complex types of restoration of chewing efficiency, which amounted to 22% of the total number of prosthetics performed in dental clinics in Bishkek, Kyrgyzstan, the optimal modern clinical and diagnostic methods that can be used according to the experience of the Biodent clinic, Bishkek were summarized. Cone-beam computed tomography recognized as the gold standard for radiological examination and modeling of dental implantation. The diagnostic accuracy was 99.2% versus 70.5% with orthopantomography. Treatment of the surface of dental titanium implants with nano-solutions of gold and silver, which have antiseptic and engraftment-improving properties in the clinic, leads to an improvement in the results of engraftment and functioning, confirmed by biochemical studies.

scholarly journals Evaluation of Loop Mediated Isothermal Amplification (LAMP) for Diagnosis of Plasmodium falciparum in Wad Medani City, Gezira State, Sudan

2019 ◽  
pp. 1-7
Author(s):  
M. Y. Mohamed ◽  
A. D. Abakar ◽  
B. A. Talha ◽  
Salah Eldin G. Elzaki ◽  
Y. A. Mohammed ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Falciparum Malaria ◽  
Diagnostic Performance ◽  
Lamp Assay ◽  
Isothermal Amplification ◽  
Teaching Hospitals ◽  
Molecular Technique ◽  
Rrna Gene ◽  
Predictive Values ◽  
Loop Mediated Isothermal Amplification

Plasmodium falciparum considered as the most serious form of species causes malaria compared with other species. Diagnosis of falciparum malaria in Sudan remain a major problem, the laboratory diagnosis depends solely on microscopy and RDTs. Loop mediated isothermal amplification (LAMP) assay is a molecular technique done in isothermal temperature using simple, inexpensive instruments for detection of falciparum malaria. The aim of the study is to evaluate the diagnostic performance of loop mediated isothermal amplification (LAMP) assay for detection of P. falciparum and compare with microscopic detection. A cross sectional hospital based study conducted on 220 blood samples collected from participants suspected to have falciparum malaria attending Wad Medani Teaching Hospitals and 26 healthy participants during the period November 2018 to January 2019. Thick blood films were done and used for P. falciparum detection. The extracted DNA by TE buffer was amplified by LAMP assay targeting 18S rRNA gene. Data were analyzed using Medical calculator (MedCalc) programs (V. 16). The results showed that the sensitivity, specificity, positive predictive value, negative predictive values were 99.1%, 84.6%, 53.2%, 99.8% respectively. Validation of LAMP diagnostic performance revealed that area under the curve is 0.919, while Weighted Kappa is 0.866. The study concluded that the LAMP assay had the identical diagnostic performance compared with microscopy in diagnosis of Plasmodium falciparum malaria. This gives a relative effortlessness application of LAMP assay in Sudan after availing the required logistics.

scholarly journals Detecting Plasmodium falciparum in community surveys: a comparison of Paracheck Pf® Test and ICT Malaria Pf® Cassette Test to polymerase chain reaction in Mutasa District, Zimbabwe

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Nobert Mudare ◽  
Zvifadzo Matsena-Zingoni ◽  
Aramu Makuwaza ◽  
Edmore Mamini ◽  
Shungu S. Munyati ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Plasmodium Falciparum ◽  
Mitochondrial Gene ◽  
Dried Blood Spots ◽  
Diagnostic Methods ◽  
Chain Reaction ◽  
Cross Sectional ◽  
Predictive Values ◽  
Polymerase Chain ◽  
Pcr Targeting

Abstract Background Microscopy and rapid diagnostic tests (RDTs) are the main techniques used to diagnose malaria. While microscopy is considered the gold standard, RDTs have established popularity as they allow for rapid diagnosis with minimal technical skills. This study aimed to compare the diagnostic performance of two Plasmodium falciparum histidine-rich protein 2 (PfHRP2)-based RDTs (Paracheck Pf® Test (Paracheck) and Malaria Pf™ ICT (ICT)) to polymerase chain reaction (PCR) in a community survey. Methods A cross-sectional study was conducted between October 2012 and December 2014 in Mutasa District, Manicaland Province, eastern Zimbabwe. Households were randomly selected using satellite imagery, and 224 households were visited. Residents present in the household on the date of the visit were recruited for the study. Participants of all age groups from the selected households were screened with Paracheck and ICT RDTs in parallel. Dried blood spots (DBS) and thin and thick smears were collected. Parasite DNA extracted from the DBS was subjected to nested PCR targeting the Plasmodium cytochrome b mitochondrial gene. Data analysis was performed using the Cohen’s Kappa test to determine the interrater agreement and the sensitivity and specificity of the diagnostic test were reported. Results Results from a total of 702 participants were analysed. Most were females, 397 (57%), and the median age of participants was 21 years with an interquartile range of 9–39 years. Of those who were screened, 8 (1.1%), 35 (5.0%), and 21 (2.9%) were malaria parasite positive by microscopy, RDT and PCR, respectively. Paracheck and ICT RDTs had a 100% agreement. Comparing RDT and PCR results, 34 participants (4.8%) had discordant results. Most of the discordant cases were RDT positive but PCR negative (n = 24). Half of those RDT positive, but PCR negative individuals reported anti-malarials to use in the past month, which is significantly higher than reported anti-malarial drug use in the population (p < 0.001). The participant was febrile on the day of the visit, but relying on PfHRP2-based RDT would miss this case. Among the diagnostic methods evaluated, with reference to PCR, the sensitivity was higher with the RDT (52.4%) while specificity was higher with the microscopy (99.9%). The positive predictive value (PPV) was higher with the microscopy (87.5%), while the negative predictive values were similar for both microscopy and RDTs (98%). Overall, a strong correlated agreement with PCR was observed for the microscopy (97.9%) and the RDTs (95.2%). Conclusions Paracheck and ICT RDTs showed 100% agreement and can be used interchangeably. As malaria transmission declines and Zimbabwe aims to reach malaria elimination, management of infected individuals with low parasitaemia as well as non-P. falciparum infection can be critical.

scholarly journals Diagnostic Performance of Artificial Intelligence-Centred Systems in the Diagnosis and Postoperative Surveillance of Upper Gastrointestinal Malignancies Using Computed Tomography Imaging: A Systematic Review and Meta-Analysis of Diagnostic Accuracy

2021 ◽  
Author(s):  
Swathikan Chidambaram ◽  
Viknesh Sounderajah ◽  
Nick Maynard ◽  
Sheraz R. Markar
Keyword(s):  
Artificial Intelligence ◽  
Gastric Cancer ◽  
Systematic Review ◽  
Esophageal Cancer ◽  
Diagnostic Accuracy ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Diagnostic Methods ◽  
Gastrointestinal Malignancies ◽  
Upper Gastrointestinal

Abstract Background Upper gastrointestinal cancers are aggressive malignancies with poor prognosis, even following multimodality therapy. As such, they require timely and accurate diagnostic and surveillance strategies; however, such radiological workflows necessitate considerable expertise and resource to maintain. In order to lessen the workload upon already stretched health systems, there has been increasing focus on the development and use of artificial intelligence (AI)-centred diagnostic systems. This systematic review summarizes the clinical applicability and diagnostic performance of AI-centred systems in the diagnosis and surveillance of esophagogastric cancers. Methods A systematic review was performed using the MEDLINE, EMBASE, Cochrane Review, and Scopus databases. Articles on the use of AI and radiomics for the diagnosis and surveillance of patients with esophageal cancer were evaluated, and quality assessment of studies was performed using the QUADAS-2 tool. A meta-analysis was performed to assess the diagnostic accuracy of sequencing methodologies. Results Thirty-six studies that described the use of AI were included in the qualitative synthesis and six studies involving 1352 patients were included in the quantitative analysis. Of these six studies, four studies assessed the utility of AI in gastric cancer diagnosis, one study assessed its utility for diagnosing esophageal cancer, and one study assessed its utility for surveillance. The pooled sensitivity and specificity were 73.4% (64.6–80.7) and 89.7% (82.7–94.1), respectively. Conclusions AI systems have shown promise in diagnosing and monitoring esophageal and gastric cancer, particularly when combined with existing diagnostic methods. Further work is needed to further develop systems of greater accuracy and greater consideration of the clinical workflows that they aim to integrate within.

scholarly journals HPV E6/E7 mRNA test for the detection of high grade cervical intraepithelial neoplasia (CIN2+): A systematic review

2019 ◽  
Author(s):  
Awoke Derbie ◽  
Daniel Mekonnen ◽  
Yimtubeznash Woldeamanuel ◽  
Xaveer Van Ostade ◽  
Tamrat Abebe
Keyword(s):  
Systematic Review ◽  
Coming Out ◽  
Gold Standard ◽  
Diagnostic Performance ◽  
Grey Literature ◽  
High Grade ◽  
Operating Characteristics ◽  
Cervical Lesions ◽  
Predictive Values ◽  
Hpv E6

Abstract Background: Genital infection with certain types of Human papillomavirus (HPV) is a major cause of cervical cancer globally. For early detection of premalignant dysplasia, evidences are coming out on the usefulness of HPV E6/E7 mRNA test as a potential tool compared with cytology and HPV DNA testing. Taking into account shortage of compiled data on this field, the aim of this systematic review was to describe the latest diagnostic performance of HPV E6/E7 mRNA testing to detect high grade cervical lesions (CIN2+) where by histology as was taken as a ‘gold standard’. Methods: Articles published in English were systematically searched using key words from PubMed/Medline and SCOPUS. In addition, Google Scholar and the Google database were searched manually for grey literature. Two reviewers independently assessed study eligibility, risk of bias and extracted the data. We performed a descriptive presentation of the performance of E6/E7 mRNA testings (interims of sensitivity, specificity, negative and positive predictive values) for the detection of CIN2+. Results: Out of 231 applicable citations, we have included 29 articles with a total of 23,576 study participants (age range, 15-84) who had different cervical pathologies. Among the participants who had cervical histology, the proportion of CIN2+ was between 10.6% and 90.6%. Using histology as a gold standard, 11 studies evaluated the PreTect HPV Proofer, 7 studies evaluated the APTIMA HPV assay (Gen-Probe) and 6 studies evaluated the Quantivirus® HPV assay. The diagnostic performance of those three most common mRNA testing tools to detect CIN2+ was; 1) PreTect Proofer; median sensitivity 83%, median specificity 73%, median PPV 70 and median NPV 88.9%. 2) APTIMA assay; median sensitivity 91.4%, median specificity 46.2%, median PPV 34.3% and median NPV 96.3%. 3) Quantivirus®: median sensitivity 86.1%, median specificity 54.6%, median PPV 54.3%, median NPV 89.3%. Further, the area under the receiver operating characteristics (AU-ROC) curve varied between 63.8% and 90.9%. Conclusions: The reported diagnostic accuracy implies that mRNA tests possess diagnostic relevance to detect CIN2+ and could potentially be considered in areas where there is no histology facility. Further studies including its cost should be considered.

The Diagnostic Accuracy of Cytology for the Diagnosis of Hepatobiliary and Pancreatic Cancers

2018 ◽  
Vol 62 (4) ◽  
pp. 311-316
Author(s):  
Marwan Al-Hajeili ◽  
Maryam Alqassas ◽  
Astabraq Alomran ◽  
Bashaer Batarfi ◽  
Bashaer Basunaid ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Biliary Tree ◽  
Needle Aspiration ◽  
Diagnostic Methods ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Histological Confirmation

Objective: Although cytology testing is considered a valuable method to diagnose tumors that are difficult to access such as hepato-biliary-pancreatic (HBP) malignancies, its diagnostic accuracy remains unclear. We therefore aimed to investigate the diagnostic accuracy of cytology testing for HBP tumors. Study Design: We performed a retrospective study of all cytology samples that were used to confirm radiologically detected HBP tumors between 2002 and 2016. The cytology techniques used in our center included fine needle aspiration (FNA), brush cytology, and aspiration of bile. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated in comparison to histological confirmation. Results: From a total of 133 medical records, we calculated an overall sensitivity of 76%, specificity of 74%, a negative likelihood ratio of 0.30, and a positive likelihood ratio of 2.9. Cytology was more accurate in diagnosing lesions of the liver (sensitivity 79%, specificity 57%) and biliary tree (sensitivity 100%, specificity 50%) compared to pancreatic (sensitivity 60%, specificity 83%) and gallbladder lesions (sensitivity 50%, specificity 85%). Cytology was more accurate in detecting primary cancers (sensitivity 77%, specificity 73%) when compared to metastatic cancers (sensitivity 73%, specificity 100%). FNA was the most frequently used cytological technique to diagnose HBP lesions (sensitivity 78.8%). Conclusion: Cytological testing is efficient in diagnosing HBP cancers, especially for hepatobiliary tumors. Given its relative simplicity, cost-effectiveness, and paucity of alternative diagnostic methods, cytology should still be considered as a first-line tool for diagnosing HBP malignancies.

Diagnostic Accuracy of Increased Mean Platelet Volume as Inflammatory Marker in Diagnosis of Acute Appendicitis Taking Histopathology as Gold Standard

2021 ◽  
Vol 15 (10) ◽  
pp. 2790-2792
Author(s):  
Hina Rehman Siddiqui ◽  
Tahira Tariq ◽  
Samar Babiker Awadallah Omer ◽  
Nadia Rizvi
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Gold Standard ◽  
Mean Platelet Volume ◽  
Inflammatory Marker ◽  
Total Leukocyte Count ◽  
Platelet Volume ◽  
Duration Of Symptoms ◽  
Predictive Values ◽  
Sensitivity Specificity

Objective: To determine diagnostic accuracy of increased mean platelet volume as inflammatory marker in diagnosis of acute appendicitis taking histopathology as gold standard. Study Design: Cross Sectional Study. Setting: Department of Surgery, Abbasi Shaheed Hospital, Karachi. Duration: From 28th October 2016 To 27thApril 2017. Material and Methods: Total 229patients suffered from acute appendicitis were included. Venous blood (<20 ml) for complete blood count was sent to lab before surgery. MPV >11fl was taken as increased value. Post-appendicectomy appendix was sent for histopathology. Sensitivity, specificity, positive and negative predictive values were calculated. Stratification was done. Chi-square test was applied post stratification and p-value ≤0.05 was considered as significant. Results: There were 128 male and 101 female. Mean age was 34.09±6.63 years. Mean duration of symptoms was 28.97±11.89 hours. 107 patients were observed with total leukocyte count >10X103µL. Mean platelets volume was more than 11 fl in 47.2% patients. Sensitivity, Specificity, PPV, NPV and accuracy were 74.6%, 91.6%, 92.5%, 71.9%, and 81.6% respectively. Conclusion: In conclusion in patients with temporary diagnosis of acute appendicitis, high MPV “≥ 11fl” can assist in the identification of acute appendicitis hence negative rate of appendectomy can be decreased.. Keywords: Diagnostic Accuracy, Increased Mean Platelet Volume, Acute Appendicitis, Histopathology

Cuff Leak Test for the Diagnosis of Post-Extubation Stridor: A Multicenter Evaluation Study

2017 ◽  
Vol 34 (5) ◽  
pp. 391-396 ◽  
Author(s):  
David Schnell ◽  
Benjamin Planquette ◽  
Asaël Berger ◽  
Sybille Merceron ◽  
Julien Mayaux ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Diagnostic Performance ◽  
Prolonged Mechanical Ventilation ◽  
Evaluation Study ◽  
High Rate ◽  
Leak Test ◽  
Predictive Values ◽  
Cuff Leak ◽  
Multicenter Prospective Study

Background: Cuff leak test was developed to predict the occurrence of post-extubation stridor (PES). This study evaluated the diagnostic performance of this test in unselected critically ill patients. Methods: Multicenter prospective study including unselected ventilated patients at the time of their first planned extubation. The diagnostic performance of 4 different cuff leak tests was assessed. Results: Post-extubation stridor occurred in 34 (9.4%) of 362 included patients. Compared to patients without PES, patients with PES required more frequently reintubation (6 [17.6%] vs 26 [7.9%], P = .041), prolonged duration of ventilation (6 [3-13] vs 5 [2-9] days, P = .029), and longer intensive care unit (ICU) stay (12 [6-17.5] vs 7.5 [4-13] days, P = .018). However, ICU mortality was similar in both groups (1 [2.9%] vs 23 [7.0%], P = .61). The 4 cuff leak tests display poor diagnostic accuracy: sensitivities ranging from 27% to 46%, specificities from 70% to 88%, positive predictive values from 14% to 19%, and negative predictive values from 92% to 93%. Conclusion: Post-extubation stridor occurs in less than 10% of unselected critically ill patients. The several cuff leak tests display limited diagnostic performance for the detection of PES. Given the high rate of false positives, routine cuff leak test may expose to undue prolonged mechanical ventilation.

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