Preoperative false-negative transthoracic echocardiographic results in native valve infective endocarditis patients: a retrospective study from 2001 to 2018

Abstract Background Infective endocarditis (IE) is a lethal disease that is difficult to diagnosis early. Although echocardiography is one of the most widely used diagnostic technique, it has limited sensitivity. This study surveyed the clinical features of IE patients who underwent surgery and compared transthoracic echocardiography and histological findings to explore the factors related to false-negative echocardiographic results. Methods Medical records were extracted from IE patients consecutively hospitalized between June 2001 and June 2018. Results A total of 182 patients with native valve IE who underwent surgery were included. Compared to the non-surgery group, the surgery group was more likely to have pre-existing valvular lesions and more serious cardiac conditions and a relative lack of signs of infection and cerebrovascular events, leading to a lower proportion of “definite cases” before surgery. The false-negative rate of echocardiography was 14.5%. Echocardiography has significant disadvantages in diagnosing perivalvular abscesses, valve perforations, and left-sided endocarditis, especially for subjects with both aortic and mitral valve infections. The multivariate analysis identified congenital heart disease and small vegetations (< 10 mm) as independent predictors of false-negative echocardiography results. Conversely, fever and heart murmurs on admission served as protective factors. Conclusions Under some circumstances, echocardiography provides inconsistent results compared with surgical findings, and negative echocardiography results do not rule out IE. The diagnosis of IE depends on comprehensive evaluations using multiple methods.

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Preoperative false-negative transthoracic echocardiographic results in native valve infective endocarditis patients: a retrospective study from 2001 to 2018

10.21203/rs.3.rs-39647/v2 ◽

2020 ◽

Author(s):

Zuning Ren ◽

Jian Zhang ◽

Hongjie Chen ◽

Xichao Mo ◽

Shaohang Cai ◽

...

Keyword(s):

Infective Endocarditis ◽

False Negative ◽

False Negative Rate ◽

Diagnostic Technique ◽

Native Valve ◽

Surgery Group ◽

Cerebrovascular Events ◽

Comprehensive Evaluations ◽

Valvular Lesions ◽

Rule Out

Abstract Background: Infective endocarditis (IE) is a lethal disease that is difficult to diagnosis early. Although echocardiography is one of the most widely used diagnostic technique, it has limited sensitivity. This study surveyed the clinical features of IE patients who underwent surgery and compared transthoracic echocardiography and histological findings to explore the factors related to false-negative echocardiographic results.Methods: Medical records were extracted from IE patients consecutively hospitalized between June 2001 and June 2018.Results: A total of 182 patients with native valve IE who underwent surgery were included. Compared to the non-surgery group, the surgery group was more likely to have pre-existing valvular lesions and more serious cardiac conditions and a relative lack of signs of infection and cerebrovascular events, leading to a lower proportion of “definite cases” before surgery. The false-negative rate of echocardiography was 14.5%. Echocardiography has significant disadvantages in diagnosing perivalvular abscesses, valve perforations, and left-sided endocarditis, especially for subjects with both aortic and mitral valve infections. The multivariate analysis identified congenital heart disease and small vegetations (<10 mm) as independent predictors of false-negative echocardiography results. Conversely, fever and heart murmurs on admission served as protective factors.Conclusions: Under some circumstances, echocardiography provides inconsistent results compared with surgical findings, and negative echocardiography results do not rule out IE. The diagnosis of IE depends on comprehensive evaluations using multiple methods.

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Preoperative false-negative transthoracic echocardiographic results in native valve infective endocarditis patients: a retrospective study from 2001 to 2018

10.21203/rs.3.rs-39647/v3 ◽

2020 ◽

Author(s):

Zuning Ren ◽

Jian Zhang ◽

Hongjie Chen ◽

Xichao Mo ◽

Shaohang Cai ◽

...

Keyword(s):

Infective Endocarditis ◽

False Negative ◽

False Negative Rate ◽

Diagnostic Technique ◽

Native Valve ◽

Surgery Group ◽

Cerebrovascular Events ◽

Comprehensive Evaluations ◽

Valvular Lesions ◽

Rule Out

Abstract Background: Infective endocarditis (IE) is a lethal disease that is difficult to diagnosis early. Although echocardiography is one of the most widely used diagnostic technique, it has limited sensitivity. This study surveyed the clinical features of IE patients who underwent surgery and compared transthoracic echocardiography and histological findings to explore the factors related to false-negative echocardiographic results.Methods: Medical records were extracted from IE patients consecutively hospitalized between June 2001 and June 2018. Results: A total of 182 patients with native valve IE who underwent surgery were included. Compared to the non-surgery group, the surgery group was more likely to have pre-existing valvular lesions and more serious cardiac conditions and a relative lack of signs of infection and cerebrovascular events, leading to a lower proportion of “definite cases” before surgery. The false-negative rate of echocardiography was 14.5%. Echocardiography has significant disadvantages in diagnosing perivalvular abscesses, valve perforations, and left-sided endocarditis, especially for subjects with both aortic and mitral valve infections. The multivariate analysis identified congenital heart disease and small vegetations (<10 mm) as independent predictors of false-negative echocardiography results. Conversely, fever and heart murmurs on admission served as protective factors. Conclusions: Under some circumstances, echocardiography provides inconsistent results compared with surgical findings, and negative echocardiography results do not rule out IE. The diagnosis of IE depends on comprehensive evaluations using multiple methods.

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Preoperative False-Negative Transthoracic Echocardiographic Results in Native Valve Infective Endocarditis Patients: A Retrospective Study from 2001 To 2018

10.21203/rs.3.rs-39647/v1 ◽

2020 ◽

Author(s):

Zuning Ren ◽

Jian Zhang ◽

Hongjie Chen ◽

Xichao Mo ◽

Shaohang Cai ◽

...

Keyword(s):

Infective Endocarditis ◽

False Negative ◽

False Negative Rate ◽

Diagnostic Technique ◽

Native Valve ◽

Surgery Group ◽

Cerebrovascular Events ◽

Comprehensive Evaluations ◽

Valvular Lesions ◽

Rule Out

Abstract Background: Infective endocarditis (IE) is a lethal disease that is difficult to diagnosis early. Although echocardiography is one of the most widely used diagnostic technique, it has limited sensitivity. This study surveyed the clinical features of IE patients who underwent surgery and compared transthoracic echocardiography and histological findings to explore the factors related to false-negative echocardiographic results.Methods: Medical records were extracted from IE patients consecutively hospitalized between June 2001 and June 2018. Results: A total of 182 patients with native valve IE who underwent surgery were included. Compared to the non-surgery group, the surgery group was more likely to have pre-existing valvular lesions and more serious cardiac conditions and a relative lack of signs of infection and cerebrovascular events, leading to a lower proportion of “definite cases” before surgery. The false-negative rate of echocardiography was 14.5%. Echocardiography has significant disadvantages in diagnosing perivalvular abscesses, valve perforations, and left-sided endocarditis, especially for subjects with both aortic and mitral valve infections. The multivariate analysis identified congenital heart disease and small vegetations (<10 mm) as independent predictors of false-negative echocardiography results. Conversely, fever and heart murmurs on admission served as protective factors. Conclusions: Under some circumstances, echocardiography provides inconsistent results compared with surgical findings, and negative echocardiography results do not rule out IE. The diagnosis of IE depends on comprehensive evaluations using multiple methods.

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Three Years of Experience With Random Urinary Homovanillic and Vanillylmandelic Acid Levels in the Diagnosis of Neuroblastoma

PEDIATRICS ◽

10.1542/peds.79.2.203 ◽

1987 ◽

Vol 79 (2) ◽

pp. 203-205

Author(s):

Mendel Tuchman ◽

Margaret L. R. Ramnaraine ◽

William G. Woods ◽

William Krivit

Keyword(s):

False Positive ◽

Homovanillic Acid ◽

False Negative ◽

False Negative Rate ◽

Urine Samples ◽

Vanillylmandelic Acid ◽

Test Results ◽

Upper Limit ◽

Positive Results ◽

Rule Out

During the last 3 years, random urine samples from 408 patients were tested for elevated homovanillic acid (HVA) and vanillylmandelic acid (VMA) levels to rule out the diagnosis of neuroblastoma. Thirty-seven of these patients had elevated HVA and/or VMA levels, and neuroblastoma was subsequently diagnosed. In three additional patients with negative test results (normal HVA and VMA levels), tumors were subsequently diagnosed (false-negative rate of 7.5%). Ten percent of the patients with neuroblastoma had normal HVA and 27.5% had normal VMA levels at the time of diagnosis. Only one patient (2.5%) with neuroblastoma had elevated VMA levels in the presence of normal HVA levels. More than 60% of the patients with neuroblastoma had urinary HVA and/or VMA levels higher than twice the upper limit of normal. No false-positive results were encountered. Age and stage distributions of the patients are shown, and the significance of the results is discussed.

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Novel low-delta value troponin algorithms have good precision for rule-out of NSTE-ACS

European Heart Journal ◽

10.1093/ehjci/ehaa946.1684 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Tjora ◽

O.T Steiro ◽

J Langorgen ◽

T Omland ◽

P Collinson ◽

...

Keyword(s):

False Negative ◽

False Negative Rate ◽

High Sensitivity ◽

Public Institution ◽

University Hospital ◽

P Value ◽

Funding Source ◽

Good Precision ◽

Serum Samples ◽

Rule Out

Abstract Background Rapid rule-out algorithms for non-ST-elevation infarction (NSTEMI) may be beneficial for logistics in the emergency room. Current algorithms are designed to rule-out NSTEMI, but do not differentiate between unstable angina (UAP) in need of revascularization and non-cardiac chest pain patients (NCCP) who could be discharged. Recent improvements in analytical precision of high sensitivity troponin (cTn) assays allow for trialing algorithms with very small delta values. Purpose Could the use of lower delta values produce rule-out algorithms for NSTE-ACS with a false negative rate of ≤5%, and a sufficient high rule-out rate of patients with NCCP. Method 927 patients with suspected NSTE-ACS were consecutively included. Serum samples were collected at 0, 3 and 8–12 hours. The final diagnosis was adjudicated by two independent cardiologists based on all clinical data including routine cTnT. The 0- and 3-hour samples were additionally measured for cTnIand cTnI from Singulex Clarity System (cTnI(sgx)). The diagnostic performance to rule-out NSTE-ACS was compared between one low-delta value algorithm from each assay (cTnT, cTnI and cTnT). Results The prevalence of NSTEMI was 13.4%, UAP 11.4% and NCCP 60%. Median age was 63 years, 60% males. Fig. 1 shows baseline and 3-hour delta cTn values for the UAP and NCCP patients for the three different assays. The baseline cTn value differed significantly between UAP and NCCP for all assays, p value <0.001. The novel low-delta cTnT algorithm (Table 1) ruled out 8 NSTE-ACS patients (3.5%), the cTnI algorithm and cTnI (sgx) algorithm ruled out 11 (4.8%) and 12 (5.2%) patients with NSTE-ACS, respectively. Moreover, the cTnT algorithm allocated 35.3% of the NCCP patients to discharge. Respective numbers for the cTnI(sgx) and cTnI algorithm were 30.6% and 33.5%. Comparing the ROC curves, the cTnT algorithm had significantly higher AUC compared to the cTnI(sgx) algorithm (p value =0.005, DeLong test). Conclusion The low-delta value algorithms correctly ruled in ≥95% of the NSTE-ACS patients whilst >30% of NCCP patients were ruled out. The cTnT algorithm had the best performance with a significant higher AUC compared to the cTnI(sgx) algorithm. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Western Norway Regional Health Authority, Haukeland and Stavanger University hospital

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P104: Evaluating the use of the pulmonary embolism rule-out criteria in the emergency department

CJEM ◽

10.1017/cem.2018.302 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S93-S94

Author(s):

S. Sharif ◽

C. Kearon ◽

M. Eventov ◽

M. Li ◽

P. Sneath ◽

...

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

False Negative ◽

False Negative Rate ◽

Signs And Symptoms ◽

Ct Scanning ◽

Pulmonary Angiogram ◽

Ct Angiogram ◽

D Dimer ◽

Rule Out

Introduction: Diagnosing pulmonary embolism (PE) can be challenging because the signs and symptoms are often non-specific. Studies have shown that evidence-based algorithms are not always adhered to in the Emergency Department (ED), which leads to unnecessary CT scanning. The pulmonary embolism rule-out criteria (PERC) can identify patients who can be safely discharged from the ED without further investigation for PE. The purpose of this study is to evaluate the use of the PERC rule in the ED and to compare the rates of testing for PE if the PERC rule was used. Methods: This was a health records review of ED patients investigated for PE at two emergency departments over a two-year period (April 2013-March 2015). Inclusion criteria were ED physician ordered CT pulmonary angiogram, ventilation-perfusion scan, or D-dimer for investigation of PE. Patients under the age of 18 were excluded. PE was considered to be present during the emergency department visit if PE was diagnosed on CT or VQ (subsegmental level or above), or if the patient was subsequently found to have PE or deep vein thrombosis during the next 30 days. Trained researchers extracted anonymized data. The rate of CT/VQ imaging and the negative predictive value was calculated. Results: There were 1,163 patients that were tested for PE and 1,097 patients were eligible for our analysis. Of the total, 330/1,097 (30.1%; 95%CI 27.4-32.3%) had CT/VQ imaging for PE, and 48/1,097 (4.4%; 95%CI 3.3-5.8%) patients were diagnosed with PE. 806/1,097 (73.5%; 95%CI 70.8-76.0%) were PERC positive, and of these, 44 patients had a PE (5.5%; 95%CI 4.1-7.3%). Conversely, 291/1,097 (26.5%; 95%CI 24.0-29.2%) patients were PERC negative, and of these, 4 patients had a PE (1.4%; 95%CI 0.5-3.5%). Of the PERC negative patients, 291/291 (100.0%; 95%CI 98.7-100.0%) had a D-dimer test done, and 33/291 (11.3%; 95%CI 8.2-15.5%) had a CT angiogram. If PERC was used, CT/VQ imaging would have been avoided in 33/1,097 (3%; 95%CI 2.2-4.2%) patients and the D-dimer would have been avoided in 291/1,097 (26.5%; 95%CI 24.0-29.2%) patients. Conclusion: If the PERC rule was used in all patients with suspected PE, fewer patients would have further testing. The false negative rate for the PERC rule was low.

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ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging

Neurology ◽

10.1212/wnl.0000000000003814 ◽

2017 ◽

Vol 88 (15) ◽

pp. 1468-1477 ◽

Cited By ~ 69

Author(s):

Alexander Andrea Tarnutzer ◽

Seung-Han Lee ◽

Karen A. Robinson ◽

Zheyu Wang ◽

Jonathan A. Edlow ◽

...

Keyword(s):

Ischemic Stroke ◽

Diagnostic Accuracy ◽

Clinical Presentation ◽

False Negative ◽

False Negative Rate ◽

Diagnostic Errors ◽

Risk Of Bias ◽

Future Research ◽

Negative Rate ◽

Cerebrovascular Events

Objective:With the emergency department (ED) being a high-risk site for diagnostic errors, we sought to estimate ED diagnostic accuracy for identifying acute cerebrovascular events.Methods:MEDLINE and Embase were searched for studies (1995–2016) reporting ED diagnostic accuracy for ischemic stroke, TIA, or subarachnoid hemorrhage (SAH). Two independent reviewers determined inclusion. We identified 1,693 unique citations, examined 214 full articles, and analyzed 23 studies. Studies were rated on risk of bias (QUADAS-2). Diagnostic data were extracted. We prospectively defined clinical presentation subgroups to compare odds of misdiagnosis.Results:Included studies reported on 15,721 patients. Studies were at low risk of bias. Overall sensitivity (91.3% [95% confidence interval (CI) 90.7–92.0]) and specificity (92.7% [91.7–93.7]) for a cerebrovascular etiology was high, but there was significant variation based on clinical presentation. Misdiagnosis was more frequent among subgroups with milder (SAH with normal vs abnormal mental state; false-negative rate 23.8% vs 4.2%, odds ratio [OR] 7.03 [4.80–10.31]), nonspecific (dizziness vs motor findings; false-negative rate 39.4% vs 4.4%, OR 14.22 [9.76–20.74]), or transient (TIA vs ischemic stroke; false discovery rate 59.7% vs 11.7%, OR 11.21 [6.66–18.89]) symptoms.Conclusions:Roughly 9% of cerebrovascular events are missed at initial ED presentation. Risk of misdiagnosis is much greater when presenting neurologic complaints are mild, nonspecific, or transient (range 24%–60%). This difference suggests that many misdiagnoses relate to symptom-specific factors. Future research should emphasize studying causes and designing error-reduction strategies in symptom-specific subgroups at greatest risk of misdiagnosis.

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Automation in Sputum Microscopy

Advances in Computational Intelligence and Robotics - Handbook of Research on Advanced Hybrid Intelligent Techniques and Applications ◽

10.4018/978-1-4666-9474-3.ch014 ◽

2016 ◽

pp. 414-453 ◽

Cited By ~ 1

Author(s):

Pramit Ghosh ◽

Debotosh Bhattacharjee ◽

Mita Nasipuri

Keyword(s):

Image Processing ◽

Mycobacterium Tuberculosis ◽

Soft Computing ◽

False Negative ◽

Hybrid Approach ◽

False Negative Rate ◽

Diagnostic System ◽

Diagnostic Technique ◽

Point Of View ◽

Sputum Microscopy

This chapter describes an automatic intelligent diagnostic system for Tuberculosis. Sputum microscopy is the most common diagnostic technique to diagnose Tuberculosis. In Sputum microscopy, Sputum are examined using a microscope for Mycobacterium tuberculosis. This manual process is being automated by image processing, where classification is performed by using a hybrid approach (color based and shape based). This hybrid approach reduces the false positive and false negative rate. Final classification decision is taken by a fuzzy system. Image processing, soft-computing, mechanics, and control system plays a significant role in this system. Slides are given as input to the system. System finds for Mycobacterium tuberculosis bacteria and generates reports. From designing point of view ARM11 based, 32 bit RISC processor is used to control the mechanical units. The main mathematical calculation (including image processing and soft computing) is distributed between ARM11 based group and Personal Computer (Intel i3). This system has better sensitivity than manual sputum microscopy.

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Retrospective analysis of gene expression profiling and TTF-1 staining in cancer of unknown primary (CUP).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.10579 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 10579-10579

Author(s):

Wendy M. Chiang ◽

Gary M. Strauss ◽

J. Scott Nystrom

Keyword(s):

Gene Expression ◽

Gene Expression Profiling ◽

Expression Profiling ◽

Small Cell Lung Carcinoma ◽

False Negative ◽

False Negative Rate ◽

Diagnostic Technique ◽

Unknown Primary ◽

Site Location ◽

Cell Lung Carcinoma

10579 Background: CUP involves extensive use of immunohistochemical (IHC) stains because no individual marker is highly both site specific or sensitive. IHC algorithms lack standardization and may even eliminate actual primary sites. Extensive validation studies with gene expression profiling (GEP) has shown it be a new diagnostic technique that further contributes tumor site location in CUP. Thyroid transcription factor-1 (TTF-1) IHC stain is commonly used to identify the pulmonary origin of CUP (particularly adenocarcinoma) and is often used to exclude lung primary in CUP patients. This study evaluates the utility of TTF-1 staining in lung primaries (specifically non-small cell lung carcinoma - NSCLC) of CUP to GEP testing. Methods: This retrospective study contains data obtained from a registry of physicians who received the GEP-based Tissue of Origin (TOO) test (Pathwork Diagnostic, Sunnyvale, CA) between 07/2009 and 12/2009 on CUP cases. Sixty-six physicians contributed 111 TOO test cases. Only cases that had TTF-1 done were included for analysis and these were compared to TOO NSCLC results. Results: Out of 111 cases, there were 73 analyzable TTF-1 results with 12 cases of NSCLC and 61 cases of non-NSCLC by TOO (see TABLE). Assuming that the results of TOO testing accurately indicated the true primary site, the sensitivity and specificity of TTF-1 was 50% and 90%, respectively. The false negative rate was 50%, indicating that half of the identified NSCLC cases in this series had negative TTF-1. On the other hand, 10% of the 61 cases with primaries other than NSCLC (none of whom had thyroid cancer), had positive TTF-1. The “false positive” TTF-1 cases comprised 4 ovarian, 1 breast and 1 colorectal as the site of origin. Conclusions: TTF-1 has limited utility in identifying NSCLC in the setting of CUP. Half of NSCLCs identified by TOO testing had negative TTF-1, and 10% of non-lung primaries were TTF-1 positive. Negative TTF-1 should not be used to exclude NSCLC in the workup of CUP. [Table: see text]

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Clinically Meaningful Change

Methodology ◽

10.1027/1614-2241/a000168 ◽

2019 ◽

Vol 15 (3) ◽

pp. 97-105

Author(s):

Rodrigo Ferrer ◽

Antonio Pardo

Keyword(s):

Effect Size ◽

False Negative ◽

False Negative Rate ◽

Point Of View ◽

Skewed Distribution ◽

Effect Sizes ◽

False Negatives ◽

Large Size ◽

Before And After ◽

Post Test

Abstract. In a recent paper, Ferrer and Pardo (2014) tested several distribution-based methods designed to assess when test scores obtained before and after an intervention reflect a statistically reliable change. However, we still do not know how these methods perform from the point of view of false negatives. For this purpose, we have simulated change scenarios (different effect sizes in a pre-post-test design) with distributions of different shapes and with different sample sizes. For each simulated scenario, we generated 1,000 samples. In each sample, we recorded the false-negative rate of the five distribution-based methods with the best performance from the point of view of the false positives. Our results have revealed unacceptable rates of false negatives even with effects of very large size, starting from 31.8% in an optimistic scenario (effect size of 2.0 and a normal distribution) to 99.9% in the worst scenario (effect size of 0.2 and a highly skewed distribution). Therefore, our results suggest that the widely used distribution-based methods must be applied with caution in a clinical context, because they need huge effect sizes to detect a true change. However, we made some considerations regarding the effect size and the cut-off points commonly used which allow us to be more precise in our estimates.

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