scholarly journals FAST and abnormal urinalysis: the effective screening tools in pediatric abdominal trauma

2018 ◽  
Vol 5 (1) ◽  
pp. 14-18
Author(s):  
Majid Zamani ◽  
Farhad Heydari ◽  
Mehrdad Esmailian
Keyword(s):  
Diagnostic Accuracy ◽  
Ct Scan ◽  
Abdominal Trauma ◽  
Predictive Value ◽  
Radiation Risk ◽  
Diagnostic Value ◽  
Screening Tools ◽  
Accuracy Evaluation ◽  
Abdominal Ultrasonography ◽  
Predictive Values

Objective: The present study examines the diagnostic accuracy of abdominal ultrasonography and urinalysis test in children with blunt abdominal trauma, compared with CT scan. The aim of this study was to compare the diagnostic value of ultrasound and urinalysis test with CT scan as a golden standard diagnostic method in predicting abdominal peritoneal injury in these patients. Methods: This prospective study, based on diagnostic accuracy evaluation, was performed on children with blunt abdominal traumas less than 12 years of age who were referred to the emergency department from 2017-2018 and for whom abdominal ultrasonography, urinalysis and abdominal CT scans were requested. Demographic data, mechanism of trauma, the results of urine tests, ultrasound and CT scan of the abdomen were recorded. Sensitivity, specificity, positive and negative predictive values were used to measure the diagnostic power of the tests. Results: In this study, 100 children with multiple traumas were included. The mean age of these patients was 5.75 ± 3 years with a range of 1-12 years. In terms of sexual distribution, 69 (69%) were boys and 31 (31%) were girls. According to the results, ultrasound with an abnormal urinalysis test had sensitivity of 85.7%, specificity of 91.9%, positive predictive value of 63.2% and negative predictive value of 97.5%. The accuracy was 91%. Conclusion: According to the results of this study, the combination of ultrasonography and urinalysis resulted in a significant increase in diagnostic value (P <0.001). Pediatric patients with a negative ultrasonography and urinalysis test should be observed rather than subjected to the radiation risk of CT

scholarly journals Diagnostic Accuracy of Magnetic Resonance Images and Weight-Bearing Radiographs in Patients With Arthroscopic-Proven Medial Osteoarthritis of the Knee

2020 ◽  
Vol 13 ◽  
pp. 117954412093836
Author(s):  
Nuria Muñoz-García ◽  
José Cordero-Ampuero ◽  
Rosario Madero-Jarabo
Keyword(s):  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Weight Bearing ◽  
Diagnostic Value ◽  
Magnetic Resonance Images ◽  
Osteoarthritis Of The Knee ◽  
Predictive Values ◽  
Arthroscopic Findings ◽  
Sensitivity Specificity

Aims: The aim of this study is to analyze the diagnostic value of weight-bearing radiographs, magnetic resonance images (MRI), and the combination of both in osteoarthritic knees when using arthroscopic findings as the “gold standard” to compare with. Methods: A total of 59 patients were studied because of chronic pain in 1 of their knees. Radiographs were classified according to Kellgren-Lawrence scale. Magnetic resonance images were classified according to Vallotton, and arthroscopic findings according to Outerbridge criteria. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were, respectively, 75.0%, 60.0%, 56.2%, 77.8%, and 66.1% for weight-bearing radiographs, and 70.8%, 88.6%, 81.0%, 81.6%, and 81.4% for MRI. Logistic regression analysis showed that a weight-bearing radiograph added to MRI offered no additional diagnostic value compared with MRI alone ( P < .001). Conclusions: Magnetic resonance images presented higher specificity, positive and negative predictive values, and accuracy than weight-bearing radiographs for knee osteoarthritis. The combination of radiographs and MRI did not improve the diagnostic accuracy, compared with MRI alone.

“A COMPARATIVE STUDY OF RIPASA SCORE AND ALVARADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS”

2021 ◽  
pp. 25-28
Author(s):  
M. Vijaya Kumar ◽  
Manasa Manasa
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scoring System ◽  
Local Population ◽  
Scoring Systems ◽  
Signs And Symptoms ◽  
Alvarado Score ◽  
Predictive Values ◽  
Ripasa Score

Acute appendicitis is the most common condition encountered in the Emergency department .Alvarado and Modied Alvarado scores are the most commonly used scoring system used for diagnosing acute appendicitis.,but its performance has been found to be poor in certain population . Hence our aim was to compare the diagnostic accuracy of RIPASA and ALVARADO Scoring system and study and compare sensitivity, specicity and predictive values of these scoring systems. The study was conducted in Government district hospital Nandyal . We enrolled 176 patients who presented with RIF pain . Both RIPASA and ALVARADO were applied to them. Final diagnosis was conrmed either by CT scan, intra operative nding or post operative HPE report. Sensitivity,specicity, positive predictive value, negative predictive value, diagnostic accuracy was calculated both for RIPASA and ALVARADO. It was found that sensitivity and specicity of the RIPASA score in our study are 98.7% and 83.3%, respectively. PPV and NPV were 98.1% and 88.2% and sensitivity and specicity of the Alvardo score in our study are 94.3% and 83.3%, respectively. PPV and NPV were 98% and 62.5%.Diagnostic accuracy of RIPASA score and Alvarado score are 97% and 93% respectively. RIPASA is a more specic and accurate scoring system in our local population when compared to ALVARADO . It reduces the number of missed appendicitis cases and also convincingly lters out the group of patients that would need a CT scan for diagnosis (score 5-7.5 ) BACKGROUND: Acute appendicitis is one of the most commonly dealt surgical emergencies, with a lifetime prevalence rate of approximately 1 one in seven. The incidence is 1.5–1.9 per 1,000 in the male and female population, and is approximately 1.4 times greater in men than in women. Despite being a common problem, it remains a difcult diagnosis to establish, particularly among the young, the elderly and females of reproductive age, where a host of other genitourinary and gynaecological inammatory conditions can present with signs and symptoms that are 2 similar to those of acute appendicitis. A delay in performing an appendectomy in order to improve its diagnostic accuracy increases the risk of appendicular perforation and peritonitis, which in turn increases morbidity and mortality. A variable combination of clinical signs and symptoms has been used together with laboratory ndings in several scoring systems proposed for suggesting the probability of Acute Appendicitis and the possible subsequent management pathway. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and ALVARADO score are new diagnostic scoring systems developed for the diagnosis of Acute Appendicitis and has been shown to have signicantly higher sensitivity, specicity and diagnostic accuracy. AIMS AND OBJECTIVES PRIMARY OBJECT 1. To compare RIPASA Scoring system and ALVARADO Scoring system in terms of diagnostic accuracy in Acute Appendicitis. 2. To study and compare sensitivity, specicity and predictive values of above scoring systems. SECONDARY OBJECT 1. To study the rate of negative appendicectomy based on above scoring systems. CONCLUSION: The RIPASA score is a simple scoring system with high sensitivity and specicity for the diagnosis of acute appendicitis. The 14 clinical parameters are all present in a good clinical history and examination and can be easily and quickly applied. Therefore, a decision on the management can be made early. Although the RIPASA score was developed for the local population of Brunei, we believe that it should be applicable to other regions. The RIPASA score presents greater Diagnostic accuracy and Sensitivity and equal specicity as a diagnostic test compared to the Alvarado score and is helpful in making appropriate therapeutic decisions. In hospitals like ours, the diagnosis of AA relies greatly on the clinical evaluation performed by surgeons. An adequate clinical scoring system would avoid diagnostic errors, maintaining a satisfactory low rate of negative appendectomies by adequate patient stratication, while limiting patient exposure to ionizing radiation, since 21 there is an increased risk of developing cancer with computed tomography, particularly for the paediatric age group.

scholarly journals Role of Liver Enzymes in Patients with Blunt Abdominal Trauma to Diagnose Liver Injury

2020 ◽  
Author(s):  
Anup Shrestha ◽  
Harish Chandra Neupane ◽  
Kishor Kumar Tamrakar ◽  
Abhishek Bhattarai ◽  
Gaurav Katwal
Keyword(s):  
Liver Injury ◽  
Confidence Interval ◽  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Predictive Value ◽  
Liver Enzymes ◽  
Tertiary Center ◽  
Significant Difference

Abstract Background:The liver is the second most injured organ following blunt abdominal trauma (BAT) after spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it is not readily available in the hospital. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury.Method:The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) study from February 2019 to May 2020. During that period 96 patients with BAT presented to the emergency department(ED) of CMCTH.Results:Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (<0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89(95% Confidence Interval 0.86-0.98) and of ALT was 0.92(95% Confidence Interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7 %, a specificity of 90 %, a positive predictive value of 86.8 %, and a negative predictive value of 77.6 %. The corresponding values for ALT ≥ 80 U/l were 77.8 %, 94.1%, 92.1% and 82.8 %, respectively.ConclusionIn conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l respectively. The elevated level of AST and ALT might assist the surgeons to timely refer the suspected patients with the liver to a tertiary center and it might help the surgeons to go for conservative management for minor liver injuries in BAT preventing the exposure hazards of the CT scan.

scholarly journals Diagnostic Value of CK19, HBME-1 and TROP2 Biomarkers in Identification of Different Types of Thyroid Follicular Neoplasms

2021 ◽  
Author(s):  
Shohreh Vojuhi ◽  
Masoud Mohebbi ◽  
Zohreh Mousavi ◽  
Mohammadali Yaghoubi ◽  
Reza Ziaolhagh
Keyword(s):  
Positive Predictive Value ◽  
Papillary Carcinoma ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Follicular Adenoma ◽  
Thyroid Neoplasms ◽  
Diagnostic Value ◽  
Cross Sectional ◽  
Predictive Values ◽  
Different Types

Thyroid malignancies are found in 7% to 15% of all thyroid nodules. Immunohistochemical markers, including CK19, HBME-1and TROP2, have shown an effective role in identifying these malignancies. Hence, due to the lack of appropriate diagnostic tests for the identification of thyroid neoplasms, in this study, we aimed to determine the diagnostic value of these biomarkers in the identification of different types of follicular thyroid neoplasms. In this cross-sectional study, paraffin-embedded tissue blocks from the surgical resection of patients with thyroid nodules, referring to Imam Reza and Razavi Hospitals of Mashhad in 2017, were studied. Sensitivity, specificity, and positive and negative predictive values of these biomarkers for the identification of different types of follicular thyroid neoplasms were also studied. 129 patients with a mean age of 44.65±12.59 years participated in this study, of whom 101 (78.29%) were women. The most common type of follicular thyroid neoplasm was papillary carcinoma (60.47%). The highest sensitivity (94.87%) and positive predictive value (68.51%) in the detection of follicular neoplasms was observed by CK19 in papillary carcinoma. The sensitivity and positive predictive value of TROP2 in the detection of papillary neoplasms was 93.58% and 75.25%, respectively. In addition, HBME-1 had the highest specificity (72.54 %) and positive predictive value (81.57%) in identifying this neoplasm. The results of this study showed that CK19, HBME-1, and TROP2 had high diagnostic value in the detection of papillary thyroid neoplasms. Although these biomarkers had low diagnostic value in identifying follicular adenoma and carcinoma, given the high negative predictive value, they can be considered as powerful markers in identifying negative cases.

scholarly journals EVALUATING THE PREDICTIVE VALIDITY OF THE NIPISSING DISTRICT DEVELOPMENTAL SCREEN IN PRIMARY CARE SETTINGS AT THE 18-MONTH HEALTH SUPERVISION VISIT

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e37-e37
Author(s):  
Vinusha Gunaseelan ◽  
Patricia Parkin ◽  
Imaan Bayoumi ◽  
Patricia Jiang ◽  
Alexandra Medline ◽  
...  
Keyword(s):  
Primary Care ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Developmental Delay ◽  
Predictive Validity ◽  
Predictive Value ◽  
Screening Tools ◽  
Developmental Screening ◽  
Research Personnel ◽  
Health Supervision

Abstract BACKGROUND The Canadian Paediatric Society (CPS) recommends that every Canadian physician caring for young children provide an enhanced 18-month well-baby visit including the use of a developmental screening tool, such as the Nipissing District Developmental Screen (NDDS). The Province of Ontario implemented an enhanced 18-month well-baby visit specifically emphasizing the NDDS, which is now widely used in Ontario primary care. However, the diagnostic accuracy of the NDDS in identifying early developmental delays in real-world clinical settings is unknown. OBJECTIVES To assess the predictive validity of the NDDS in primary care for identifying developmental delay and prompting a specialist referral at the 18-month health supervision visit. DESIGN/METHODS This was a prospective longitudinal cohort study enrolling healthy children from primary care practices. Parents completed the 18-month NDDS during their child’s scheduled health supervision visit between January 2012 and February 2015. Using a standardized data collection form, research personnel abstracted data from the child’s health records regarding the child’s developmental outcomes following the 18-month assessment. Data collected included confirmed diagnoses of a development delay, specialist referrals, family history, and interventions. Research personnel were blind to the results of the NDDS. We assessed the diagnostic test properties of the NDDS with a confirmed diagnosis of developmental delay as the criterion measure. The specificity, sensitivity, positive predictive value, and negative predictive value were calculated, with 95% confidence intervals. RESULTS We included 255 children with a mean age of 18.5 months (range, 17.5–20.6) and 139 (55%) were male. 102 (40%) screened positive (1+ flag result on their NDDS). A total of 48 (19%) children were referred, and 23 (9%) had a confirmed diagnosis of a developmental delay (speech and language: 14; gross motor: 4; autism spectrum disorder: 3; global developmental delay: 1; developmental delay: 1). The sensitivity was 74% (95% CI: 52–90%), specificity was 63% (95% CI: 57–70%), positive predictive value was 17% (95% CI:10–25%), and the negative predictive value was 96% (95% CI: 92–99%). CONCLUSION For developmental screening tools, sensitivity between 70%-80% and specificity of 80% have been suggested. The NDDS has moderate sensitivity and specificity in identifying developmental delay at the 18-month health supervision visit. The 1+NDDS flag cut-point may lead to overdiagnosis with more children with typical development being referred, leading to longer wait times for specialist referrals among children in need. Future work includes investigating the diagnostic accuracy of combining the NDDS with other screening tools.

scholarly journals Diagnostic Value of Ultrasonography in Patients Suspected Acute Appendicitis

2013 ◽  
Vol 2 (2) ◽  
pp. 13-19
Author(s):  
MA Elahifar ◽  
H Taheri ◽  
A Bighamian
Keyword(s):  
Acute Appendicitis ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Histopathological Examination ◽  
Imaging Modality ◽  
Diagnostic Value ◽  
Preoperative Imaging ◽  
Outpatient Basis ◽  
Abdominal Ultrasonography ◽  
Cell Counts

Introduction: Appendectomy is one of the most frequently performed abdominal operations in surgical practice. Preoperative imaging has been demonstrated to improve diagnostic accuracy in appendicitis. Abdominal ultrasonography (US) is the most commonly and first-line imaging modality used for diagnosing acute appendicitis (AA).The aim of this study was to demonstrate the diagnostic value of abdominal ultrasonography for diagnosing acute appendicitis. Methods: In a retrospective study, we analyzed 200 consecutive patients with abdominal pain that undergoing appendectomy, from June 2009 to April 2012. Patient characteristics, preoperative ultrasonography (US) and laboratory assessment including WBC were collected. Final diagnosis of appendicitis was confirmed by histopathological examination. Results were compared with US. Results: Two hundred patients were admitted to this study that undergoing appendectomy. Mean age was 24 years (range: 1 to 91 years), and 57% were females. Patient White blood cell counts were found to be high in 78% while it was 86% for AA group and 64% for NA group (p < 0.05). One hundred sixty-six of these patients (83%) were diagnosed as acute appendicitis on pathology, and 34 (17%) were diagnosed differently. 157 of patients underwent US, eighty two of this patients diagnosed as acute appendicitis on US examinations and in 78 of them were also reported as acute appendicitis on histopathological examination. The sensitivity and specificity of abdominal US for diagnosing appendicitis were 70% and 90.2% respectively. Positive predictive value (PPV) was 93% and negative predictive value (NPV) was reported 62%. Conclusion: Ultrasonography has a high PPV and specificity, so as a diagnostic tool, positive US strongly suggests the diagnosis of AA. A low negative predictive value recommends that negative US is not sufficient to exclude the diagnosis of AA and patients could not be managed on an outpatient basis following a negative scan. Nepalese Journal of Radiology; Vol. 2; Issue 2; July-Dec. 2012; 13-19 DOI: http://dx.doi.org/10.3126/njr.v2i2.7680

scholarly journals Noninvasive Electromagnetic Detection of Bladder Cancer

ISRN Urology ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Luigi Cormio ◽  
Clarbruno Vedruccio ◽  
Giorgio Leucci ◽  
Paolo Massenio ◽  
Giuseppe Di Fino ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
False Negative ◽  
Electromagnetic Properties ◽  
Urinary Cytology ◽  
Predictive Values ◽  
Electromagnetic Detection ◽  
Voiding Symptoms ◽  
Asymptomatic Patients

Objectives. Normal and neoplastic human tissues have different electromagnetic properties. This study aimed to determine the diagnostic accuracy of noninvasive electromagnetic detection of bladder cancer (BC) by the tissue-resonance interaction method (TRIM-prob). Patients and Methods. Consecutive patients were referred for cystoscopy because of (i) microscopic or gross hematuria and/or irritative voiding symptoms and (ii) bladder ultrasounds and urinary cytology findings negative or just suspicious of malignancy. Patients were first submitted to TRIM-prob bladder scanning by a single investigator and then to cystoscopy by another investigator blind to TRIM-prob data. Results. In 125 evaluated patients cystoscopy was positive for BC in 47 and negative in the remaining 78; conversely, TRIM-prob bladder scanning was positive for BC in 53 and negative in 72. In particular, TRIM-prob scanning yielded 7 false positives and only one false negative; therefore, its overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 97.9%, 89.9%, 86.8%, 98.6%, and 93.6%, respectively. Conclusions. TRIM-prob bladder scanning was a simple and quite accurate method for non-invasive electromagnetic detection of BC. If the elevated positive and negative predictive values will be replicated in further well-designed studies, it could be used to screen asymptomatic patients at high risk of BC.

Role of contrast enhanced computed tomography in assessing cervical lymph node metastases in oral cavity squamous cell carcinoma

2021 ◽  
pp. 1-10
Author(s):  
Talha Ahmed Qureshi ◽  
Muhammad Wasif ◽  
Muhammad Sohail Awan ◽  
Adnan yar Muhammad ◽  
Ainulakbar Mughal ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Oral Cavity ◽  
Diagnostic Accuracy ◽  
Ct Scan ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Predictive Value ◽  
P Value ◽  
Contrast Enhanced ◽  
Kappa Value

Abstract Objectives: To evaluate the diagnostic accuracy of contrast enhanced CT scan to detect cervical nodal metastasis in oral cavity squamous cell carcinoma keeping final histopathology as gold standard. Methods: Cross sectional study conducted from 1st January 2015 - 31st October 2016. All patients undergoing surgery who had their CT scans done at our centre were included in the study. Diagnostic accuracy of CT scans was calculated using final histopathology as gold standard. All CT scan were reviewed by consultant radiologist. Results: Total 100 patients were reviewed, 70% were female, 55% had buccal and 32% had tongue cancer. 11 cases of T1, 20 cases of T2 , 4 cases of T3 and 21 cases of T4 stages were staged similarly by CT scan and histopathology, the kappa value of38.8%, p value <0.01. 6 cases of N1, 1 case of N2a , 9 cases of N2b, 3 cases of N2c, 1 case of N3 and 29 cases of N0 stages were staged similarly by CT scan and histopathology, with kappa value of 28.1%, p value of  <0.01. Sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy were 83%,61%,70.9%,76.3% and 73% respectively. Conclusion: CT scan is useful for preoperative staging of oral cavity squamous cell carcinoma with an overall diagnostic accuracy of 73%, currently there are no superior diagnostic modalities. However, Due to low specificity and negative predictive value elective neck dissection should still be done in a negative CT scan for cervical lymph node metastases. Keywords: Oral Cavity,

Educational Review of Predictive Value and Findings of Computed Tomography Scan in Diagnosing Bowel and Mesenteric Injuries after Blunt Trauma: Correlation with Trauma Surgery Findings in 163 Patients

2017 ◽  
Vol 68 (3) ◽  
pp. 276-285 ◽  
Author(s):  
Francesco Cinquantini ◽  
Gregorio Tugnoli ◽  
Alice Piccinini ◽  
Carlo Coniglio ◽  
Sergio Mannone ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Predictive Value ◽  
Gold Standard ◽  
Clinical Management ◽  
Trauma Surgery ◽  
Trauma Patients ◽  
Increased Risk

Background and Aims Laparotomy can detect bowel and mesenteric injuries in 1.2%–5% of patients following blunt abdominal trauma. Delayed diagnosis in such cases is strongly related to increased risk of ongoing sepsis, with subsequent higher morbidity and mortality. Computed tomography (CT) scanning is the gold standard in the evaluation of blunt abdominal trauma, being accurate in the diagnosis of bowel and mesenteric injuries in case of hemodynamically stable trauma patients. Aims of the present study are to 1) review the correlation between CT signs and intraoperative findings in case of bowel and mesenteric injuries following blunt abdominal trauma, analysing the correlation between radiological features and intraoperative findings from our experience on 25 trauma patients with small bowel and mesenteric injuries (SBMI); 2) identify the diagnostic specificity of those signs found at CT with practical considerations on the following clinical management; and 3) distinguish the bowel and mesenteric injuries requiring immediate surgical intervention from those amenable to initial nonoperative management. Materials and Methods Between January 1, 2008, and May 31, 2010, 163 patients required laparotomy following blunt abdominal trauma. Among them, 25 patients presented bowel or mesenteric injuries. Data were analysed retrospectively, correlating operative surgical reports with the preoperative CT findings. Results We are presenting a pictorial review of significant and frequent findings of bowel and mesenteric lesions at CT scan, confirmed intraoperatively at laparotomy. Moreover, the predictive value of CT scan for SBMI is assessed. Conclusions Multidetector CT scan is the gold standard in the assessment of intra-abdominal blunt abdominal trauma for not only parenchymal organs injuries but also detecting SBMI; in the presence of specific signs it provides an accurate assessment of hollow viscus injuries, helping the trauma surgeons to choose the correct initial clinical management.

Interpretations of the dial test should be reconsidered. A diagnostic accuracy study reporting sensitivity, specificity, predictive values and likelihood ratios

2018 ◽  
Vol 3 (4) ◽  
pp. 198-204
Author(s):  
Richard Norris ◽  
Christian Kopkow ◽  
Michael James McNicholas
Keyword(s):  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Knee Ligament ◽  
Predictive Values ◽  
Medial Knee ◽  
Sensitivity Specificity ◽  
Dial Test

ObjectivesTo determine the accuracy of the dial test, used alone and in combination with additional clinical tests, in the diagnosis of an isolated posterolateral corner (PLC) injury, combined PLC-posterior cruciate ligament (PCL) injury or medial knee injury.MethodsA retrospective analysis of consecutive patients who underwent arthroscopic and/or open knee ligament reconstruction surgery was conducted. The dial test was performed in an outpatient’s clinic as part of a routine knee examination. Examination under anaesthetic and intraoperative findings were used as the reference standard test to determine the diagnostic accuracy of the dial test used alone and in combination with other PCL and medial knee tests. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−) were calculated with corresponding 95% CI.ResultsData from 87 patients were available and included in the data analysis. For an isolated PLC injury, the dial test sensitivity and specificity were 0.20 (95% CI 0.08 to 0.39) and 1.00 (95% CI 0.92 to 1.00). The PPV and NPV were 1.00 (95% CI 0.52 to 1.00) and 0.70 (95% CI 0.59 to 0.80). LR+ and LR− of the dial test detecting isolated PLC injury were infinity (95% CI calculation not possible, infinity) and 0.80 (95% CI 0.41 to 1.57). The diagnostic accuracy of the dial test, when used alone and in combination with other PCL and medial knee tests, was also calculated for combined PLC-PCL and medial knee injuries.ConclusionA negative dial test at 30° of knee flexion can rule out a PLC injury, while a test that is positive at 30° and negative at 90° indicates a PLC injury, without concomitant injury to the PCL or medial knee ligaments. A positive test at both 30° and 90° can indicate isolated PLC, combined PLC-PCL or medial ligament injuries, and other knee examination findings are required to differentially diagnose these injury patterns.Level of evidenceII.

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