Validation of the Dutch leakage score as a predictor of anastomotic leakage in intestinal surgery in a third level hospital

Background: Intestinal surgery can present multiple complications that can lead to patient death; therefore, it is important to design early detection strategies to reduce complications in patients with intestinal anastomosis and thus avoid patient death. The aim of this work is to evaluate the diagnostic performance of the Dutch leakage score in 125 patients with intestinal anastomosis as a predictor of anastomotic leakage.Methods: In a sample of 125 patients undergoing intestinal anastomosis, demographic variables were identified and the Dutch leakage score was applied. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were obtained using a 2×2 table.Results: The Dutch leakage score was positive in 23.2% (29 patients) of whom 24 had anastomotic leakage and 5 had no anastomotic leakage. It presents a sensitivity in the test of 100%, a specificity of 95%, a positive predictive value of 82.7%, a negative predictive value of 100%. The diagnostic accuracy is 96%.Conclusions: The Dutch leakage score is a versatile tool, inexpensive, easy to apply and available in any hospital center. It is capable of early diagnosis of anastomotic leakage. It favors early re-intervention, improves prognosis and survival, decreases hospital stay and health care costs.

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Diagnostic accuracy of monofilament test to detect diabetic neuropathy

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v10i1.37086 ◽

2021 ◽

Vol 10 (1) ◽

pp. 20-25

Author(s):

Sujan Shrestha ◽

Mamen Prasad Gorhaly ◽

Manil Ratna Bajracharya

Keyword(s):

Peripheral Neuropathy ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Diabetic Peripheral Neuropathy ◽

Perception Threshold ◽

Sensitivity Specificity ◽

Vibration Perception ◽

Monofilament Test

Background Diabetic peripheral neuropathy (DPN) is a significant independent risk factor for diabetic foot, and an effective screening instrument is required to diagnose DPN early to prevent future ulceration and amputation. This study aims to determine the diagnostic accuracy of monofilament test to detect diabetic peripheral neuropathy. Methods This cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital, Mahabouddha, Kathmandu from February 2016 to January 2017. A total of 96 diabetic patients attending inpatient and outpatient Department were selected. Diabetic peripheral neuropathy was assessed by measurement of loss of protective sensation (LOPS) by monofilament test and compared with vibration perception threshold by standard biothesiometer. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were calculated. Results The prevalence of diabetic peripheral neuropathy was 26%. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were found to be 92.0%, 95.8%, 88.5% and 97.1% respectively. There was strong association between LOPS by monofilament and vibration perception threshold by biothesiometer. Conclusion This study showed a strong diagnostic accuracy of monofilament test to detect DPN when compared with biothesiometer. As monofilament test is a cheap, easily available, and portable, it can be used in the periphery where biothesiometer is not available.

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DIAGNOSTIC ACCURACY OF GRAY SCALE ULTRASONOGRAPHY VERSUS COLOR DOPPLER IN SUSPECTED CASES OF ACUTE APPENDICITIS

The International Journal of Frontier Sciences ◽

10.37978/tijfs.v5i1.319 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Tahir Iqbal ◽

Muhammad Usman Shahid ◽

Ishfaq Ahmad Shad ◽

Shahzad Karim Bhatti ◽

Syed Amir Gilani ◽

...

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Color Doppler ◽

Diagnostic Tools ◽

Gray Scale ◽

Versus Color ◽

Sensitivity Specificity

ABSTRACT: BACKGROUND: A common surgical emergency is acute appendicitis. Various diagnostic tools are available to diagnosis acute appendicitis. Radiological investigations play an important role in making accurate and early diagnosis and thus preventing morbidity associated with the disease. OBJECTIVE: To determine the diagnostic accuracy of gray scale ultrasonography versus color Doppler in suspected cases of acute appendicitis. MATERIALS AND METHODS: The study was carried in the department of Radiology of Mayo Hospital, Lahore. A total of 75 patients were enrolled of age 18-40 years, both genders who were suspected cases of acute appendicitis. All patients underwent baseline investigations along with gray scale ultrasonography and color Doppler. All patients were subjected to surgery to confirm the diagnosis and findings were subjected to statistical analysis. RESULTS: The mean age of the patients was 23.25 ±10.55 and mean transverse diameter of appendix was 8.37 ±3.39. There were 62.7% males and 37.3%females. Findings of gray scale ultrasonography and color Doppler were then correlated with surgical findings to calculate the diagnostic accuracy of these modalities. The results revealed that gray scale ultrasonography sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 92.7%, 94.32%, 95%, 91.4% and 93.3% respectively, whereas color Doppler had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97.7%, 93.9%, 95.3%, 97% and 96% respectively. Diagnostic accuracy of both modalities together was 98.6%. CONCLUSION: Color Doppler has better diagnostic accuracy than gray scale ultrasonography for diagnosis of acute appendicitis and the combination of both modalities yields diagnostic accuracy that is similar to gold standard.

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A Comparative Analysis Between RIPASA and Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis- A Nepalese Perspective

Journal of Lumbini Medical College ◽

10.22502/jlmc.v6i2.264 ◽

2018 ◽

Vol 6 (2) ◽

Author(s):

Suman Baral ◽

Neeraj Thapa ◽

Raj Kumar Chhetri ◽

Rupesh Sharma

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Scoring Systems ◽

Negative Appendectomy ◽

Alvarado Score ◽

Sensitivity Specificity

Introduction: Various diagnostic criteria have been described for acute appendicitis. For decades the most commonly used one has been Alvarado score. RIPASA scoring system has also been developed for Asian population which has shown highest sensitivity and diagnostic accuracy. This study aimed to compare these two diagnostic criteria in Nepalese population attending a tertiary center. Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination was taken as the gold standard for diagnosis. Statistical analysis was done using McNemar's test as applicable. Results: Ninety nine (90 %) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 94.5%, 27.27 %, 92.16 %, 37.5 %, 88.18% and 7.84% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 71.72%, 72.73 %, 95.95 %, 22.22%, 71.82 %, and 4.05 % respectively. 94.5% of patients were correctly stratified by RIPASA under higher probability group while only 71.8 % were classified by Alvarado (p value= 0.0001). Conclusion: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, this method can be applied in Nepalese setting for the diagnosis of acute appendicitis.

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Diagnostic Accuracy of Ultrasound in Palpable Breast Lesions

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i3.33697 ◽

2020 ◽

Vol 5 (3) ◽

pp. 1196-1200

Author(s):

Manish Raj Pathak ◽

Mahesh Gautam ◽

Rashmita Bhandari

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Diagnostic Tool ◽

Predictive Value ◽

Breast Lesions ◽

Non Invasive ◽

Malignant Lesions ◽

Palpable Breast ◽

Sensitivity Specificity

Introduction: Breast carcinoma is the second leading cause of cancer related mortality in females around the world. Ultrasound plays a key role in differentiating cystic and solid lesions and is a convenient and non-invasive diagnostic tool to differentiate between benign and malignant lesions. Objectives: The aim of this study is to evaluate the diagnostic accuracy of ultrasound in palpable breast lesions. Methodology: A prospective cross-sectional study was carried out in patients with palpable breast lesions who presented in Department of radio diagnosis and imaging of Nobel Medical collegefor a period of one-year from February 2019- January 2020 using ultrasound. A total of 60 patientswereevaluated in the study. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. Results: Out of 60 patients evaluated, ultrasound showed 46 (76.7%) cases to be benign and 14 (23.3%) cases to be malignant. FNAC revealed benign disease in 47 (78.3%) patients and malignant disease in 13 (21.7%) patients. The most common benign lesion was fibroadenoma. We found nearly 91.7% of the malignant lesions had spiculated margins and microcalcification. The sensitivity of ultrasound was 95.74% and specificity 92.3% with diagnostic accuracy 95%. Conclusion: Ultrasound is a convenient and non-invasive diagnostic tool with good sensitivity, specificity, positive predictive value, negative predictive value and accuracy in palpable breast lesions.

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Prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resection

BMC Surgery ◽

10.1186/s12893-020-00995-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lukas F. Liesenfeld ◽

Peter Sauer ◽

Markus K. Diener ◽

Ulf Hinz ◽

Thomas Schmidt ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Anastomotic Leakage ◽

Negative Predictive Value ◽

Predictive Value ◽

Inflammatory Markers ◽

Prognostic Value ◽

Predictive Marker ◽

Esophageal Resection ◽

Predictive Values ◽

Sensitivity Specificity

Abstract Background Early diagnosis of anastomotic leakage (AL) after esophageal resection is crucial for the successful management of this complication. Inflammatory serological markers are indicators of complications during the postoperative course. The aim of the present study was to evaluate the prognostic value of routine inflammatory markers to predict anastomotic leakage after transthoracic esophageal resection. Methods Data from all consecutive patients undergoing transthoracic esophageal resection between January 2010 and December 2016 were analyzed from a prospective database. Besides clinicodemographic parameters, C-reactive protein, white blood cell count and albumin were analyzed and the Noble/Underwood (NUn) score was calculated to evaluate their predictive value for postoperative anastomotic leakage. Diagnostic accuracy was measured by sensitivity, specificity, and negative and positive predictive values using area under the receiver operator characteristics curve. Results Overall, 233 patients with transthoracic esophageal resection were analyzed, 30-day mortality in this group was 3.4%. 57 patients (24.5%) suffered from AL, 176 patients were in the AL negative group. We found significant differences in WBCC, CRP and NUn scores between patients with and without AL, but the analyzed markers did not show an independent relevant prognostic value. For CRP levels below 155 mg/dl from POD3 to POD 7 the negative predictive value for absence of AI was > 80%. Highest diagnostic accuracy was detected for CRP levels on 4th POD with a cut-off value of 145 mg/l reaching negative predictive value of 87%. Conclusions In contrast to their prognostic value in other surgical procedures, CRP, WBCC and NUn score cannot be recommended as independent markers for the prediction of anastomotic leakage after transthoracic esophageal resection. CRP is an accurate negative predictive marker and discrimination of AL and no-AL may be helpful for postoperative clinical management. Trial registration The study was approved by the local ethical committee (S635-2013).

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Unenhanced breast MRI: could it replace dynamic breast MRI in detecting and characterizing breast lesions?

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0103-y ◽

2020 ◽

Vol 51 (1) ◽

Cited By ~ 2

Author(s):

Reham Khalil ◽

Noha Mohamed Osman ◽

Nivine Chalabi ◽

Enas Abdel Ghany

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Breast Mri ◽

Breast Lesions ◽

Dce Mri ◽

Contrast Enhanced ◽

Mri Protocol ◽

Sensitivity Specificity

Abstract Background We aimed to evaluate the unenhanced MRI of the breast (UE-MRI) as an effective substitute for dynamic contrast-enhanced breast MRI (DCE-MRI) in both detecting and characterizing breast lesions. We enrolled in our retrospective study 125 females (232 breasts, as 18 patients had unilateral mastectomy) with breast mass at MRI of variable pathologies. Routine DCE-MRI protocol of the breast was conducted. We compared the conventional unenhanced images including STIR, T2, and DWIs to the DCE-MRI by two blinded radiologists, to detect and characterize breast lesions, and then we compared their results with the final reference diagnoses supplied by the histopathology or serial negative follow-ups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and DCE-MRI were calculated. UE-MRI results of each observer were also compared with DCE- MRI. Results The calculated UE-MRI sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the first observer were 95%, 80%, 83%, 94%, and 89% respectively, and for the second observer, they were 94%, 79%, 81%, 93%, and 86%. On the other hand, those for the DCE-MRI by the first observer were 98%, 82%, 84%, 98%, and 90% and were 97%, 81%, 84%, 97%, and 89% by the second observer. The intraobserver agreement between the UE-MRI and DCE-MRI results of each observer was 94% and 95%, while the interobserver agreement for each section was 97.4% for UE-MRI and 98.3% for DCE-MRI. Conclusion UE-MRI of the breast can be a reliable and effective substitute for breast DCE-MRI. It can be used with comparable accuracy to DCE-MRI whenever contrast administration is not feasible or contraindicated.

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ROLE OF DOPPLER INDICES IN THE PREDICTION OF ADVERSE PERINATAL OUTCOME IN PREECLAMPSIA

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i4.4567 ◽

2021 ◽

Vol 71 (4) ◽

pp. 1209-1213

Author(s):

Shakra Tabasam ◽

Zaib Malik ◽

Asifa Siraj ◽

Sadaf Afroz

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Perinatal Outcome ◽

Military Hospital ◽

Reference Standard ◽

Adverse Perinatal Outcome ◽

Doppler Study ◽

Sensitivity Specificity

Objective: To determine diagnostic accuracy of systolic/diastolic ratio and cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi, from Jun to Dec 2017. Methodology: A total of 191 patients with preeclampsia were included. Doppler ultrasound (including doppler wave forms obtained from free floating portion of umbilical artery and doppler waveform from middle cerebral artery at the level of circle of Willis) examination was done after gestational age 30 weeks and Doppler study repeated at 2-4 weeks interval depending on severity of preeclampsia and abnormalities of waveform. Cases were followed and results of last Doppler examination within 10 days of delivery were considered and perinatal outcome noted. Results: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of systolic/diastolic ratio in predicting adverse perinatal outcome among patients in preeclampsia, keeping actual adverse perinatal outcome as reference standard was 82.35%, 86.52%, 87.50%, 81.05% and 84.29% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia, keeping actual adverse perinatal outcome as reference standard was 78.67%, 92.24%, 86.76%, 86.99% and 86.91% respectively. Conclusion: The diagnostic accuracy of systolic/diastolic ratio, cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia is quite high.

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Diagnosis of Congenital Anomalies of Kidney and Ureter by Ultrasonography

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v5i1.23882 ◽

2015 ◽

Vol 5 (1) ◽

pp. 8-11

Author(s):

Fathima Nusrath Halim ◽

Mohammad Ali Sarker ◽

Farah Nazlee ◽

Md Nazrul Islam

Keyword(s):

Kidney Disease ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Congenital Anomalies ◽

Transabdominal Ultrasonography ◽

Imaging Tool ◽

Congenital Kidney Anomalies ◽

Sensitivity Specificity

Present study was conducted to investigate the diagnostic accuracy of transabdominal ultrasonography in correlation with IVU in suspected patients of Congenital anomalies of kidney and Ureter. In study, ultrasonography and IVU was done in 50 clinically suspected patients of congenital anomalies of kidney that was admitted in BSMMU, BIRDEM & DMCH during the period of July 2008 to May 2009. Patients of all ages and both sexes were included. Findings of USG and IVU were correlated. Sonographically abnormalities were diagnosed in 46 (92%) cases, out of which 45 (95.7%) also diagnosed by IVU and 1 (33.3) was normal in IVU. Out of 4 (8%) Sonographically demonstrated normal cases, 2 (4.3%) were proved normal by IVU and 2 (66.7%) cases which missed by sonography were diagnosed by IVU. Sensitivity of ultrasonography in diagnosing congenital kidney disease was 95.7% and specificity was 66.7%, positive predictive value was 97.8%, negative predictive value was 50.0% and accuracy was 94.0%. So, we conclude that ultrasonography has significant sensitivity, specificity, positive predictive value, and accuracy in diagnosis of congenital kidney anomalies correlating with IVU. As such, USG can be considered as an appropriate imaging tool for diagnosis of congenital anomalies of kidney.J. Paediatr. Surg. Bangladesh 5(1): 8-11, 2014 (January)

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A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20195099 ◽

2019 ◽

Vol 6 (11) ◽

pp. 3937

Author(s):

Waleed Yusif El Sherpiny

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Negative Appendectomy ◽

Alvarado Score ◽

Sensitivity Specificity ◽

Ripasa Score

Background: Various diagnostic criteria have been described for diagnosing acute appendicitis. Of these, Alvarado score has been the most commonly used. The RIPASA score is a new diagnostic scoring system developed for the diagnosis of acute appendicitis and showed higher sensitivity, specificity and diagnostic accuracy as compared to Alvarado score. we want to compare prospectively Alvarado and RIPASA score by applying them to patients attending emergency department complaining of right iliac fossa pain that could probably be acute appendicitis.Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination of the removed appendix was taken as the gold standard for diagnosis of acute appendicitis.Results: Among (90%) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy were 88.2%, 14.5%, 73.1%, 32%,and 68% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 51.2%, 80 %, 91 %, 29%, and 57%, respectively. 87.5% of patients were correctly stratified by RIPASA under higher probability group while only 45% were classified by Alvarado as high probability.Conclusions: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, it can be applied for the diagnosis of acute appendicitis.

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Influence of lesion location on the accuracy of CT derived FFR: head-to-head comparison with invasive FFR

European Heart Journal ◽

10.1093/ehjci/ehaa946.0158 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Moshage ◽

S Smolka ◽

S Achenbach ◽

F Ammon ◽

P Ferstl ◽

...

Keyword(s):

Coronary Angiography ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Invasive Coronary Angiography ◽

Roc Curve Analysis ◽

Jude Medical ◽

Lesion Location ◽

Distal Vessel

Abstract Background The accuracy of CT-derived FFR (FFRCT) has been repeatedly reported. However, the influence of lesion location on accuracy is unknown. Therefore, we evaluated the diagnostic accuracy of FFRCT to detect lesion-specific ischemia and determined the influence of lesion location (proximal vs. distal vessel segments) compared to invasively measured FFR in patients with suspected CAD. Methods A total of 136 vessels in which “Dual-Source”-CT coronary angiography had been performed due to suspected CAD and who were further referred for invasive coronary angiography with invasive FFR measurement within three months of the index CT examination were retrospectively identified and screened for inclusion in this analysis. Patients with either left main coronary artery stenoses, bifurcation or ostial stenoses were excluded. Invasive FFR was measured using a pressure wire (CERTUS®, St. Jude Medical, Minnesota, USA or Verrata®, Volcano, San Diego, USA). FFRCT was calculated using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany). All vessels were analyzed by an experienced observer blinded to the results of invasive FFR. Stenoses with invasively measured FFR ≤0.80 were classified as hemodynamically significant. We evaluated the diagnostic accuracy of FFRCT in proximal vs. non-proximal vessel segments. Proximal lesions included stenoses located in segment one, six, eleven and twelve. All other stenoses were categorized as distal lesions. Results Out of 136 coronary stenoses, 47 (35%) were located in proximal segments and 89 (65%) lesions were located in distal segments. Compared to invasive FFR, the sensitivity of FFRCT to correctly identify/exclude hemodynamically significant stenoses in proximal vessel segments was 93% (95% CI: 68–99.8%) and the specificity was 100% (95% CI: 89–100%), compared to a sensitivity of 72% (95% CI: 46.5–90%) and a specificity of 87% (95% CI: 77–94%) for FFRCT in distal lesions. The positive predictive value was 100% and the negative predictive value was 97% (95% CI: 82.8–99.5%) compared to a positive predictive value of 59% (95% CI: 42–93.9%) and a negative predictive value of 93% (95% CI: 85.4–96.3%) for proximal vs. distal vessel segment, respectively. This corresponds to an accuracy of 98% vs. 84%, respectively (p=0.02). ROC-Curve analysis showed a slightly higher – albeit non-significant – area under the curve for FFRCT to detect hemodynamic relevance in proximal lesions compared to distal lesions (AUC 0.95, p<0.001 vs. AUC: 0.86, p<0.001, respectively, p=0.2). Conclusion FFRCT obtained using an on-site prototype shows overall a high diagnostic accuracy for detecting lesions causing ischemia as compared to invasive FFR with a trend towards better diagnostic performance in proximal vessel segments. Funding Acknowledgement Type of funding source: None

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