scholarly journals Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefit

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Silvia Gianola ◽  
Greta Castellini ◽  
Annalisa Biffi ◽  
Gloria Porcu ◽  
Andrea Fabbri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Sample Size ◽  
Sensitivity And Specificity ◽  
Clinical Benefit ◽  
Major Trauma ◽  
Trauma System ◽  
Operating Characteristics ◽  
Large Variability ◽  
Net Clinical Benefit

Abstract Background We conducted a systematic review to evaluate and compare the accuracy of pre-hospital triage tools for major trauma in the context of the development of the Italian National Institute of Health guidelines on major trauma integrated management. Methods PubMed, Embase, and CENTRAL were searched up to November 2019 for studies investigating pre-hospital triage tools. The ROC (receiver operating characteristics) curve and net clinical benefit for all selected triage tools were performed. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies–2. Certainty of the evidence was judged with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results We found 15 observational studies of 13 triage tools for adults and 11 for children. In adults, according to the ROC curve and the net clinical benefit, the most reliable tool was the Northern French Alps Trauma System (TRENAU), adopting injury severity score (ISS) > 15 as reference (sensitivity (Sn), 0.92; specificity (Sp), 0.41; 1 study; sample size, 2572; high certainty of the evidence). When mortality as reference was considered, the pre-hospital triage tool with the best net clinical benefit trajectory was the New Trauma Score (NTS) < 18 (Sn, 0.82; Sp, 0.86; 1 study; sample size, 1001; moderate certainty of the evidence). In children, high variability among all triage tools for sensitivity and specificity was found. Conclusion Sensitivity and specificity varied across all available pre-hospital trauma triage tools. TRENAU and NTS are the best accurate triage tools for adults, whereas in the pediatric area a large variability prevents any firm conclusion.

scholarly journals Accuracy of Anti-GBM Antibodies in Diagnosing Anti-Glomerular Basement Membrane Disease: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-8
Author(s):  
Akihiro Shiroshita ◽  
Yasuhiro Oda ◽  
Seiji Takenouchi ◽  
Noboru Hagino ◽  
Yuki Kataoka
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Basement Membrane ◽  
Diagnostic Accuracy ◽  
Cohort Studies ◽  
Quality Assessment ◽  
Sensitivity And Specificity ◽  
Glomerular Basement Membrane ◽  
Case Control ◽  
Risk Of Bias

<b><i>Background:</i></b> The sensitivity and specificity of anti-glomerular basement membrane (GBM) antibodies have not been systematically analyzed. In this systematic review, we aimed to evaluate the diagnostic accuracy of anti-GBM antibodies for anti-GBM disease. <b><i>Summary:</i></b> Potential studies were searched using MEDLINE, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform based on the index test and target condition. The inclusion criteria were prospective or retrospective cohort studies or case-control studies assessing the sensitivity and specificity of anti-GBM antibodies, and the reference standard was clinical diagnosis including biopsy results. The exclusion criteria were review articles, case reports, animal studies, and in vitro studies. Quality assessment was conducted based on the Quality Assessment of Diagnostic Accuracy Studies-2. The pooled estimates of sensitivity and specificity were calculated using a bivariate random-effects model. The overall quality was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation. Six studies (1,691 patients) and 11 index tests were included in our systematic review. A high risk of bias and concerns regarding the applicability of patient selection were noted because of the case-control design in 67% of the included studies. The pooled sensitivity and specificity were 93% (95% CI: 84–97%) and 97% (95% CI: 94–99%), respectively. The certainty of evidence was low because of the high risk of bias and indirectness. <b><i>Key Messages:</i></b> Anti-GBM antibodies may exhibit high sensitivity and specificity in the diagnosis of anti-GBM disease. Further cohort studies are needed to confirm their precise diagnostic accuracy and compare diagnostic accuracies among different immunoassays.

scholarly journals The Challenge of Choosing the Best Classification Method in Radiomic Analyses: Recommendations and Applications to Lung Cancer CT Images

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 3088
Author(s):  
Federica Corso ◽  
Giulia Tini ◽  
Giuliana Lo Presti ◽  
Noemi Garau ◽  
Simone Pietro De Angelis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Sample Size ◽  
Sensitivity And Specificity ◽  
Simulated Data ◽  
Lymph Node Status ◽  
Imaging Features ◽  
Association Strength ◽  
Operating Characteristics ◽  
Computed Tomography Images ◽  
Extreme Gradient Boosting

Radiomics uses high-dimensional sets of imaging features to predict biological characteristics of tumors and clinical outcomes. The choice of the algorithm used to analyze radiomic features and perform predictions has a high impact on the results, thus the identification of adequate machine learning methods for radiomic applications is crucial. In this study we aim to identify suitable approaches of analysis for radiomic-based binary predictions, according to sample size, outcome balancing and the features–outcome association strength. Simulated data were obtained reproducing the correlation structure among 168 radiomic features extracted from Computed Tomography images of 270 Non-Small-Cell Lung Cancer (NSCLC) patients and the associated to lymph node status. Performances of six classifiers combined with six feature selection (FS) methods were assessed on the simulated data using AUC (Area Under the Receiver Operating Characteristics Curves), sensitivity, and specificity. For all the FS methods and regardless of the association strength, the tree-based classifiers Random Forest and Extreme Gradient Boosting obtained good performances (AUC ≥ 0.73), showing the best trade-off between sensitivity and specificity. On small samples, performances were generally lower than in large–medium samples and with larger variations. FS methods generally did not improve performances. Thus, in radiomic studies, we suggest evaluating the choice of FS and classifiers, considering specific sample size, balancing, and association strength.

Diagnostic accuracy of inferior vena cava ultrasound for heart failure in patients with acute dyspnoea: a systematic review and meta-analysis

2020 ◽  
pp. emermed-2019-208547
Author(s):  
Alessandro Squizzato ◽  
Lorenzo Maroni ◽  
Cristina Marrazzo ◽  
Nicoletta Riva ◽  
Luigina Guasti
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Inferior Vena Cava ◽  
Diagnostic Accuracy ◽  
Quality Assessment ◽  
Sensitivity And Specificity ◽  
Inferior Vena ◽  
Vena Cava ◽  
Weighted Mean ◽  
Acute Dyspnoea

BackgroundDyspnoea is the most common sign of heart failure (HF). Patients accessing the ED for HF-related symptoms require fast diagnosis and early treatment. Transthoracic echocardiography has a crucial role in HF diagnosis, but requires qualified staff and adequate time for execution. The measurement of inferior vena cava (IVC) diameter has been recently proposed as a rapid, simple and reliable marker of volume overload. The aim of this systematic review was to assess the accuracy of IVC-ultrasound as a stand-alone test for HF diagnosis in patients presenting to the ED with acute dyspnoea.MethodsStudies evaluating the diagnostic accuracy of the inferior vena cava collapsibility index (IVC-CIx) for HF diagnosis were systematically searched in the EMBASE and MEDLINE databases (up to January 2018). Quality Assessment of Diagnostic Accuracy Studies 2 tool was used for the quality assessment of the primary studies. A bivariate random-effects regression approach was used for summary estimates of both sensitivity and specificity.ResultsSeven studies, for a total of 591 patients, were included. Three studies were at low-risk of bias. All studies used a proper reference test. Weighted mean prevalence of HF was 49.3% at random-effect model (I2 index for heterogeneity=74.7%). IVC-CIx bivariate weighted mean sensitivity was 79.1% (95% CI 68.5% to 86.8%) and bivariate weighted mean specificity was 81.8% (95% CI 75.0% to 87.0%).ConclusionsOur findings suggest that the sensitivity and specificity of IVC-CIx are suboptimal to rule in or rule out HF diagnosis in patients with acute dyspnoea in the ED setting. Therefore, IVC-CIx is not advisable as a stand-alone test, but may be useful when integrated in a specific diagnostic algorithm for the differential diagnosis of acute dyspnoea.

scholarly journals Detection of intracranial hypertension in children using optical coherence tomography: a systematic review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037833
Author(s):  
Sohaib R Rufai ◽  
Noor ul Owase Jeelani ◽  
Rebecca J McLean
Keyword(s):  
Systematic Review ◽  
Optical Coherence Tomography ◽  
Quality Assessment ◽  
Intracranial Hypertension ◽  
Sensitivity And Specificity ◽  
Screening Tools ◽  
Optical Coherence ◽  
Systematic Review Protocol ◽  
Review Protocol

IntroductionIntracranial hypertension (ICH) in children can have deleterious effects on the brain and vision. It is notoriously difficult to estimate intracranial pressure (ICP) in children and existing methods deliver suboptimal diagnostic accuracy to be used as screening tools. Optical coherence tomography (OCT) may represent a valuable, non-invasive surrogate measure of ICP, as has been demonstrated in a number of associated conditions affecting adults. More recently, OCT has been employed within the paediatric age group. However, the role of OCT in detecting ICH in children has not been rigorously assessed in a systematic review for all relevant conditions. Here, we propose a systematic review protocol to examine the role of OCT in the detection of ICH in children.Methods and analysisElectronic searches in the Cochrane Central Register of Controlled Trials, Medline, Embase, Web of Science and PubMed will identify studies featuring OCT in detecting ICH in children. Two independent screeners will identify studies for inclusion using a screening questionnaire. The systematic search and screening will take place between 2 April 2020 and 1 June 2020, while we aim to complete data analysis by 1 September 2020. Quality assessment will be performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome measure is the sensitivity and specificity of OCT in detecting ICH in children. Secondary outcomes measures include conditions associated with ICH per study, direct ICP monitoring, sensitivity and specificity of other measures for ICP and OCT parameters used.Ethics and disseminationEthical approval is not required for the proposed systematic review as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication.PROSPERO registration numberCRD42019154254.

scholarly journals Accuracy of Deep Learning Algorithms for the Diagnosis of Retinopathy of Prematurity by Fundus Images: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Jingjing Zhang ◽  
Yangyang Liu ◽  
Toshiharu Mitsuhashi ◽  
Toshihiko Matsuo
Keyword(s):  
Systematic Review ◽  
Deep Learning ◽  
Sensitivity And Specificity ◽  
Retinopathy Of Prematurity ◽  
Meta Analysis ◽  
Automated System ◽  
Validation Dataset ◽  
Fundus Images ◽  
Operating Characteristics ◽  
Published Evidence

Background. Retinopathy of prematurity (ROP) occurs in preterm infants and may contribute to blindness. Deep learning (DL) models have been used for ophthalmologic diagnoses. We performed a systematic review and meta-analysis of published evidence to summarize and evaluate the diagnostic accuracy of DL algorithms for ROP by fundus images. Methods. We searched PubMed, EMBASE, Web of Science, and Institute of Electrical and Electronics Engineers Xplore Digital Library on June 13, 2021, for studies using a DL algorithm to distinguish individuals with ROP of different grades, which provided accuracy measurements. The pooled sensitivity and specificity values and the area under the curve (AUC) of summary receiver operating characteristics curves (SROC) summarized overall test performance. The performances in validation and test datasets were assessed together and separately. Subgroup analyses were conducted between the definition and grades of ROP. Threshold and nonthreshold effects were tested to assess biases and evaluate accuracy factors associated with DL models. Results. Nine studies with fifteen classifiers were included in our meta-analysis. A total of 521,586 objects were applied to DL models. For combined validation and test datasets in each study, the pooled sensitivity and specificity were 0.953 (95% confidence intervals (CI): 0.946–0.959) and 0.975 (0.973–0.977), respectively, and the AUC was 0.984 (0.978–0.989). For the validation dataset and test dataset, the AUC was 0.977 (0.968–0.986) and 0.987 (0.982–0.992), respectively. In the subgroup analysis of ROP vs. normal and differentiation of two ROP grades, the AUC was 0.990 (0.944–0.994) and 0.982 (0.964–0.999), respectively. Conclusions. Our study shows that DL models can play an essential role in detecting and grading ROP with high sensitivity, specificity, and repeatability. The application of a DL-based automated system may improve ROP screening and diagnosis in the future.

miR-224 is an early-stage biomarker of hepatocellular carcinoma with miR-224 and miR-125b as prognostic biomarkers

2020 ◽  
Vol 14 (15) ◽  
pp. 1485-1500
Author(s):  
Lichao Yang ◽  
Chunmeng Wei ◽  
Yasi Li ◽  
Xiao He ◽  
Min He
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Survival Analysis ◽  
Sensitivity And Specificity ◽  
Poor Prognosis ◽  
Early Stage ◽  
Meta Analysis ◽  
Benign Lesion ◽  
Diagnostic Efficiency ◽  
Low Expression

Aim: The aim was to systematically investigate the miRNA biomarkers for early diagnosis of hepatocellular carcinoma (HCC). Materials & methods: A systematic review and meta-analysis of miRNA expression in HCC were performed. Results: A total of 4903 cases from 30 original studies were comprehensively analyzed. The sensitivity and specificity of miR-224 in discriminating early-stage HCC patients from benign lesion patients were 0.868 and 0.792, which were superior to α-fetoprotein. Combined miR-224 with α-fetoprotein, the sensitivity and specificity were increased to 0.882 and 0.808. Prognostic survival analysis showed low expression of miR-125b and high expression of miR-224 were associated with poor prognosis. Conclusion: miR-224 had a prominent diagnostic efficiency in early-stage HCC, with miR-224 and miR-125b being valuable in the prognostic diagnosis.

scholarly journals Research on the Operating Characteristics of Hydraulic Free-Piston Engines: A Systematic Review and Meta-Analysis

Energies ◽  
2021 ◽  
Vol 14 (12) ◽  
pp. 3530
Author(s):  
Fukang Ma ◽  
Shuanlu Zhang ◽  
Zhenfeng Zhao ◽  
Yifang Wang
Keyword(s):  
Systematic Review ◽  
High Efficiency ◽  
Meta Analysis ◽  
Combustion Process ◽  
Research Progress ◽  
Future Research ◽  
Operating Characteristics ◽  
Piston Engine ◽  
Free Piston ◽  
Free Piston Engine

The hydraulic free-piston engine (HFPE) is a kind of hybrid-powered machine which combines the reciprocating piston-type internal combustion engine and the plunger pump as a whole. In recent years, the HFPE has been investigated by a number of research groups worldwide due to its potential advantages of high efficiency, energy savings, reduced emissions and multi-fuel operation. Therefore, our study aimed to assess the operating characteristics, core questions and research progress of HFPEs via a systematic review and meta-analysis. We included operational control, starting characteristics, misfire characteristics, in-cylinder working processes and operating stability. We conducted the literature search using electronic databases. The research on HFPEs has mainly concentrated on four kinds of free-piston engine, according to piston arrangement form: single piston, dual pistons, opposed pistons and four-cylinder complex configuration. HFPE research in China is mainly conducted in Zhejiang University, Tianjin University, Jilin University and the Beijing Institute of Technology. In addition, in China, research has mainly focused on the in-cylinder combustion process while a piston is free by considering in-cylinder combustion machinery and piston dynamics. Regarding future research, it is very important that we solve the instabilities brought about by chance fluctuations in the combustion process, which will involve the hydraulic system’s efficiency, the cyclical variation, the method of predicting instability and the recovery after instability.

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