The predictive value of protein, glucose, and lactate for a diagnosis of neoplastic meningitis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e12005-e12005
Author(s):  
Jonathan McClain ◽  
Michael J. Glantz
Keyword(s):  
Solid Tumors ◽  
Roc Curves ◽  
Neoplastic Meningitis ◽  
Screening Tools ◽  
Csf Cytology ◽  
Likelihood Ratios ◽  
Positive Cytology ◽  
At Risk Populations ◽  
Cancer Types ◽  
Sensitivity Specificity

e12005 Background: Neoplastic Meningitis (NM) is a complication of many common cancers that occurs with an incidence as high as 15% in some cancer types. Diagnosis remains elusive with poor screening tools and insensitive diagnostic options. Methods: A retrospective analysis of 341 consecutive patients with suspected NM was undertaken. Clinical presentation, demographic, cytologic and MRI data were recorded. Using cytology as the diagnostic gold standard, sensitivity, specificity, ROC curves and likelihood ratios were calculated. Results: 210 patients met inclusion criteria, 87 with primary brain tumors (PBT), 72 with non-CNS solid tumors, and 44 with lymphomas. 111 patients were male; 123 (58.6%) ultimately had a positive cytology. Only 59% of patients with positive cytology presented with symptoms concerning for NM. 32.9% of patients with PBTs and positive CSF cytology exhibited neurologic symptoms suggestive of NM. Patients with non-CNS solid tumors and positive CSF cytology presented with symptoms concerning for NM 80% of the time. Patients with cytology-positive, MRI-positive and symptom-positive NM had very different survivals. Potentially informative CSF values are in table below. Conclusions: A definitive diagnosis for patients with suspected NM remains elusive without a positive cytology, but some clinical, radiographic, and CSF findings are useful for raising diagnostic concern, and for screening in at-risk populations. Symptom-positive or MRI-positive NM may represent different diseases than cytology-positive NM. [Table: see text]

scholarly journals The Child Behavior Checklist as a Screening Instrument for PTSD in Refugee Children

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 521
Author(s):  
Ina Nehring ◽  
Heribert Sattel ◽  
Maesa Al-Hallak ◽  
Martin Sack ◽  
Peter Henningsen ◽  
...  
Keyword(s):  
Child Behavior ◽  
Child Behavior Checklist ◽  
High Sensitivity ◽  
Roc Curves ◽  
Structured Interview ◽  
Screening Instrument ◽  
Screening Tools ◽  
Refugee Children ◽  
Post Traumatic Stress ◽  
Sensitivity Specificity

Thousands of refugees who have entered Europe experienced threatening conditions, potentially leading to post traumatic stress disorder (PTSD), which has to be detected and treated early to avoid chronic manifestation, especially in children. We aimed to evaluate and test suitable screening tools to detect PTSD in children. Syrian refugee children aged 4–14 years were examined using the PTSD-semi-structured interview, the Kinder-DIPS, and the Child Behavior Checklist (CBCL). The latter was evaluated as a potential screening tool for PTSD using (i) the CBCL-PTSD subscale and (ii) an alternative subscale consisting of a psychometrically guided selection of items with an appropriate correlation to PTSD and a sufficient prevalence (presence in more than 20% of the cases with PTSD). For both tools we calculated sensitivity, specificity, and a receiver operating characteristic (ROC) curve. Depending on the sum score of the items, the 20-item CBCL-PTSD subscale as used in previous studies yielded a maximal sensitivity of 85% and specificity of 76%. The psychometrically guided item selection resulted in a sensitivity of 85% and a specificity of 83%. The areas under the ROC curves were the same for both tools (0.9). Both subscales may be suitable as screening instrument for PTSD in refugee children, as they reveal a high sensitivity and specificity.

scholarly journals Neoplastic Meningitis: How MRI and CSF Cytology Are Influenced by CSF Cell Count and Tumor Type

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
P. Prömmel ◽  
S. Pilgram-Pastor ◽  
H. Sitter ◽  
J.-H. Buhk ◽  
H. Strik
Keyword(s):  
Cell Count ◽  
Solid Tumors ◽  
Neoplastic Meningitis ◽  
Leptomeningeal Disease ◽  
Neoplastic Disease ◽  
Tumor Type ◽  
Csf Cytology ◽  
Hematological Neoplasms ◽  
Cell Counts ◽  
Solid Malignancies

Background. Although CSF cytology and MRI are standard methods to diagnose neoplastic meningitis (NM), this complication of neoplastic disease remains difficult to detect. We therefore reevaluated the sensitivity of gadolinium (GD)-enhanced MRI and cerebrospinal-fluid (CSF)-cytology and the relevance of tumor type and CSF cell count.Methods. We retrospectively identified 111 cases of NM diagnosed in our CSF laboratory since 1990 with complete documentation of both MRI and CSF cytology. 37 had haematological and 74 solid neoplasms. CSF cell counts were increased in 74 and normal in 37 patients.Results. In hematological neoplasms, MRI was positive in 49% and CSF cytology in 97%. In solid tumors, the sensitivity of MRI was 80% and of cytology 78%. With normal CSF cell counts, MRI was positive in 59% (50% hematological, 72% solid malignancies) and CSF cytology in 76% (92% in hematological, 68% in solid neoplasms). In cases of elevated cell counts, the sensitivity of MRI was 72% (50% for hematological, 83% for solid malignancies) and of CSF cytology 91% (100% for haematological and 85% for solid neoplasms). 91% of cytologically positive cases were diagnosed at first and another 7% at second lumbar puncture. Routine protein analyses had a low sensitivity in detecting NM.Conclusions. The high overall sensitivity of MRI was only confirmed for NM from solid tumors and for elevated CSF cell counts. With normal cell counts and haematological neoplasms, CSF-cytology was superior to MRI. None of the analysed routine CSF proteins had an acceptable sensitivity and specificity in detecting leptomeningeal disease.

Hyperglycosylated hCG and Placenta Accreta Spectrum

2018 ◽  
Vol 36 (01) ◽  
pp. 022-026 ◽  
Author(s):  
Alli Straubhar ◽  
Sean Soisson ◽  
Kathryn Szczotka ◽  
Mark Dodson ◽  
Robert Silver ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Roc Curves ◽  
Control Group ◽  
Likelihood Ratios ◽  
Cut Point ◽  
Hyperglycosylated Human Chorionic Gonadotropin ◽  
Placenta Accreta Spectrum ◽  
Sensitivity Specificity ◽  
The Relationship ◽  
Control Study

Objective We aimed to evaluate the relationship between hyperglycosylated human chorionic gonadotropin (hCG-H) and placenta accreta spectrum (PAS) in the second and third trimesters of pregnancy. Study Design This was a case–control study of PAS and controls. hCG-H was measured in the second and third trimesters of pregnancy in women with pathologically confirmed cases of PAS and in gestational age-matched controls without PAS. We compared serum hCG-H levels in cases and controls, calculated summary statistics for diagnostic accuracy, and used receiver operating characteristic (ROC) curves to define an optimal cut-point for diagnosis of PAS using hCG-H. Results Thirty case samples and 30 control samples were evaluated for hCG-H. Mean hCG-H was lower in the case compared with control group (7.8 ± 5.9 μg/L vs. 11.8 ± 8.8 μg/L, p = 0.03). At an optimal cut-point for hCG-H of ≤7.6 μg/L, the sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, and area under the ROC curve were 66.7%, 69.7%, 2.20%, 0.48%, and 0.68%, respectively. Conclusion Hyperglycosylated hCG levels in the second and third trimesters of pregnancy were lower in patients with PAS than in controls, but hCG-H showed only modest capability as a diagnostic test for PAS.

The Interpretation of Test Results

2000 ◽  
Vol 4 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Michael Binder ◽  
Stephan Dreiseitl
Keyword(s):  
Decision Making ◽  
Receiver Operating Characteristic ◽  
Diagnostic Tests ◽  
Operating Characteristic ◽  
Roc Curves ◽  
Test Results ◽  
Likelihood Ratios ◽  
Clinical Routine ◽  
Predictive Values ◽  
Sensitivity Specificity

Background: Dermatologists need to interpret an increasing number of research studies and diagnostic tests. Understanding the techniques for interpreting test results and making decisions based upon those tests represent important tools for decision making for both clinicians and researchers. Objective: This article focuses briefly on the key parameters of diagnostic tests: sensitivity, specificity, prevalence, predictive values, likelihood ratios, and the concept of receiver-operating-characteristic (ROC) curves. A simple example is presented in a step-by-step manner. Conclusion: The principles of interpreting test results are easy to learn and applicable in daily clinical routine. Therefore, dermatologists should be familiar with the concepts outlined in this paper.

scholarly journals El dilema del vigilante. Valoración de pruebas diagnósticas.

2018 ◽  
Vol 10 (8) ◽  
pp. 4
Author(s):  
Manuel Molina
Keyword(s):  
Diagnostic Tests ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Significant Parameter ◽  
Quantitative Results ◽  
Sensitivity Specificity

Existen una serie de parámetros que caracterizan las pruebas diagnósticas, como son la sensibilidad, la especificidad, los valores predictivos y los cocientes de probabilidad. Solo estos últimos nos permiten el cálculo de la probabilidad del paciente de presentar la enfermedad, con independencia de la prevalencia en la población. Para caracterizar las pruebas con resultado cuantitativo se utilizan las curvas ROC, cuyo parámetro más significativo es el área bajo la curva. ABSTRACT There are a series of parameters that characterize the diagnostic tests, such as sensitivity, specificity, predictive values and likelihood ratios. Only the latter allow us to calculate the patient's probability of presenting the disease, regardless of the prevalence in the population. To characterize the tests with quantitative results, the ROC curves are used, whose most significant parameter is the area under the curve.

scholarly journals Validation of an obstructive sleep apnea symptom inventory in persons with multiple sclerosis

2021 ◽  
pp. 135245852110130
Author(s):  
Mini Singh ◽  
Ronald Gavidia ◽  
Galit Levi Dunietz ◽  
Elizabeth Washnock-Schmid ◽  
Andrew R Romeo ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Clinical Care ◽  
Roc Curves ◽  
Screening Tools ◽  
Obstructive Sleep ◽  
Threshold Score ◽  
Sensitivity Specificity ◽  
Current Screening

Background: Improved screening for obstructive sleep apnea (OSA) could enhance multiple sclerosis (MS) clinical care; yet the utility of current screening tools for OSA have yet to be evaluated in persons with multiple sclerosis (PwMS). Objectives: The STOP-Bang Questionnnaire is an 8-item screening tool for OSA that is commonly used in non-MS samples. The aim of this study was to assess the validity of the STOP-Bang in PwMS. Methods: STOP-Bang and polysomnography data were analyzed from n = 200 PwMS. Sensitivity, specificity, positive-, and negative-predictive value (PPV and NPV) were calculated, with receiving operating characteristic (ROC) curves, for each STOP-Bang threshold score, against polysomnography-confirmed OSA diagnosis at three apnea severity thresholds (mild, moderate, and severe). Results: Nearly 70% had a STOP-Bang score of ⩾3% and 78% had OSA. The STOP-Bang at a threshold score of 3 provided sensitivities of 87% and 91% to detect moderate and severe OSA, respectively; and NPV of 84% and 95% to identify PwMS without moderate or severe OSA, respectively. Sensitivity to detect milder forms of OSA was 76%. The NPV to identify persons without milder forms of OSA was 40%. Conclusion: The STOP-Bang Questionnaire is an effective tool to screen for moderate and severe OSA in PwMS, but may be insufficient to exclude mild OSA.

Health screening in occupational health

2019 ◽  
pp. 121-134
Author(s):  
David Koh ◽  
Tar-Ching Aw
Keyword(s):  
Occupational Health ◽  
Biological Effects ◽  
Roc Curves ◽  
Health Screening ◽  
Screening Tests ◽  
Likelihood Ratios ◽  
Advantages And Disadvantages ◽  
Technical Issues ◽  
Biological Effects Monitoring ◽  
Sensitivity Specificity

This chapter on health screening in occupational health describes common screening procedures in occupational health practice, such as pre-placement examination, health surveillance, and examinations prior to job reassignments. It covers biological monitoring and biological effects monitoring and discusses examples of specific screening tests such as executive health screening, genetic screening, and screening for drugs and alcohol. This chapter also reviews theoretical and technical issues in screening such as the characteristics of a screening test, for example, sensitivity, specificity, predictive value, likelihood ratios, and receiver operating characteristic (ROC) curves. The advantages and disadvantages of screening, practical and ethical aspects of screening, and finally the evaluation of screening programmes are discussed.

Can we predict suicide and non-fatal self-harm with the Beck Hopelessness Scale? A meta-analysis

2007 ◽  
Vol 37 (6) ◽  
pp. 769-778 ◽  
Author(s):  
DEAN McMILLAN ◽  
SIMON GILBODY ◽  
EMMA BERESFORD ◽  
LIZ NEILLY
Keyword(s):  
Operating Characteristic ◽  
Meta Analysis ◽  
Roc Curves ◽  
High Risk Group ◽  
Likelihood Ratios ◽  
Summary Receiver Operating Characteristic ◽  
Beck Hopelessness Scale ◽  
Self Harm ◽  
Sensitivity Specificity ◽  
Specificity Rate

Background. Hopelessness is considered a pre-eminent risk factor for suicide and non-fatal self-harm. We aimed to quantify the ability of the Beck Hopelessness Scale (BHS) to predict these two outcomes.Method. Medline, Embase, PsycINFO and Cinahl were searched to January 2006. We included cohort studies in which the BHS was applied and patients were followed-up to establish subsequent suicide or non-fatal self-harm. Four studies provided usable data on suicide, and six studies provided data on non-fatal self-harm. Summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios (DORs) were calculated for each study. Random effects meta-analytic pooling across studies at the standard cut-off point ([ges ]9) was undertaken and summary receiver operating characteristic (ROC) curves constructed.Results. For suicide, pooled sensitivity was 0·80 [95% confidence interval (CI) 0·68–0·90], pooled specificity was 0·42 (95% CI 0·41–0·44), and the pooled DOR was 3·39 (95% CI 1·29–8·88). For non-fatal self-harm, pooled sensitivity was 0·78 (95% CI 0·74–0·82), pooled specificity was 0·42 (95% CI 0·38–0·45), and the pooled DOR was 2·27 (95% CI 1·53–3·37).Conclusion. The standard cut-off point on the BHS identifies a high-risk group for potential suicide, but the magnitude of the risk is lower than previously reported estimates. The standard cut-off point is also capable of identifying those who are at risk of future self-harm, but the low specificity rate means it is unlikely to be of use in targeting treatment designed to lower the rate of repetition.

Clausal Density Between Ages 4 and 9 Years for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

2020 ◽  
pp. 1-15
Author(s):  
Ling-Yu Guo ◽  
Phyllis Schneider ◽  
William Harrison
Keyword(s):  
Diagnostic Accuracy ◽  
Psychometric Properties ◽  
Language Impairment ◽  
Reference Data ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Criterion Validity ◽  
Likelihood Ratios ◽  
Generation Task ◽  
Sensitivity Specificity

Purpose This study provided reference data and examined psychometric properties for clausal density (CD; i.e., number of clauses per utterance) in children between ages 4 and 9 years from the database of the Edmonton Narrative Norms Instrument (ENNI). Method Participants in the ENNI database included 300 children with typical language (TL) and 77 children with language impairment (LI) between the ages of 4;0 (years;months) and 9;11. Narrative samples were collected using a story generation task, in which children were asked to tell stories based on six picture sequences. CD was computed from the narrative samples. The split-half reliability, concurrent criterion validity, and diagnostic accuracy were evaluated for CD by age. Results CD scores increased significantly between ages 4 and 9 years in children with TL and those with LI. Children with TL produced higher CD scores than those with LI at each age level. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of CD scores were all significant at each age level, with the magnitude ranging from small to large. The diagnostic accuracy of CD scores, as revealed by sensitivity, specificity, and likelihood ratios, was poor. Conclusions The finding on diagnostic accuracy did not support the use of CD for identifying children with LI between ages 4 and 9 years. However, given the attested reliability and validity for CD, reference data of CD from the ENNI database can be used for evaluating children's difficulties with complex syntax and monitoring their change over time. Supplemental Material https://doi.org/10.23641/asha.13172129

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