scholarly journals A comparative study of serum ascitic fluid albumin gradient with ascitic fluid total protein in evaluating the etiology of ascites

2019 ◽  
Vol 6 (4) ◽  
pp. 1259
Author(s):  
Manigandan Gopi ◽  
Mohamed Hanifah
Keyword(s):  
Diagnostic Accuracy ◽  
Ascitic Fluid ◽  
Total Protein ◽  
Alcoholic Cirrhosis ◽  
Diagnostic Procedures ◽  
P Value ◽  
Ascites Formation ◽  
Sensitivity Specificity ◽  
Insight Into

Background: The traditional method of classification of ascites by AFTP offers little insight into the pathophysiology of ascites formation and it has many drawbacks. In order to overcome it, the classification of ascites based on SAAG has emerged. Even SAAG has some draw backs like non correlation with ascites due to non-alcoholic cirrhosis and difficulty in identifying the ascites due to mixed etiology. This study is conducted to compare the diagnostic accuracies of SAAG and AFTP in identifying the pathophysiology of ascites.Methods: A total of fifty patients who were admitted with ascites were included in the study.  Ascitic fluid total protein and SAAG were calculated. They were classified on the basis of SAAG into High SAAG and Low SAAG and on the basis of AFTP into Transudate and Exudate. After the etiology of ascites evaluated by various diagnostic procedures, the sensitivity, specificity and diagnostic accuracy of SAAG and AFTP in identifying the pathophysiology of ascites calculated sepereately. The diagnostic accuracies of SAAG and AFTP were compared statistically.Results: The sensitivity of SAAG was found to be 86.84% and that of AFTP  60%. The specificity of SAAG was found to be 83.33% and that of AFTP was found to be 60%. The diagnostic accuracy of SAAG was found to be 86% and that of AFTP was found to be 60%. The diagnostic accuracy of SAAG and AFTP for individual etiologies of ascites were found and compared. SAAG was found to be superior to AFTP with a P value of <0.01 which was statistically significant.Conclusions: The sensitivity and specificity of SAAG was superior to AFTP in identifying the etiology of ascites.

scholarly journals Comparison of Diagnostic Accuracy of Portal Serum Ascitic Albumin Gradient (SAAG) with Ascitic Fluid Total Protien (AFTP) Differentiating Portal Hypertension from Non-Portal in Patients with Ascites

2021 ◽  
Vol 15 (6) ◽  
pp. 1924-1926
Author(s):  
Salman Khan ◽  
Ihsan Ullah ◽  
Moeen ul Haq ◽  
Umar Badshah ◽  
Maryam Nazir
Keyword(s):  
Portal Hypertension ◽  
Serum Albumin ◽  
Diagnostic Accuracy ◽  
Ascitic Fluid ◽  
Total Protein ◽  
Ascites Fluid ◽  
P Value ◽  
Total Proteins ◽  
Local Data ◽  
Hospital Laboratory

Introduction: Although majority of the cases of ascites have cirrhosis, there are 15% patients where there is a non-hepatic cause of fluid retention like malignancy, congestive heart failure and tuberculous peritonitis. Ascites is the most common complication of cirrhosis that leads to hospital admission. Objective:To compare the diagnostic Accuracy of Serum Ascitic Albumin Gradient (SAAG) and Ascitic Fluid Total Proteins in patients with ascites by taking Ultrasound abdomen & Pelvis as gold standard. There are international studies on the accuracy of SAAG in determining cause of ascites but not much local data. Additionally, SAAG is not widely used in our setup. The results of this study will add to the existing knowledge and will help in the diagnosis and better management of these patients. Material & Methods: A cross sectional validation study was conducted in the department of General Medicine, DHQTH, Dera Ismail Khan from 29th April to 29th Oct, 2019. Diagnostic Ascitic fluid was aspirated from the peritoneal cavity and ascitic fluid was sent to hospital laboratory for total protein and albumin. Blood was taken at the same time and was send to the hospital laboratory for the serum albumin. SAAG was calculated by subtracting ascitic albumin value from the serum albumin value. Both, Ascitic fluid total protein and SAAG values was documented in the proforma. Ultrasound Abdomen & Pelvis was done on each patient with special instruction for radiologist to comment upon Portal Vein diameter and any changes in its diameter with respiration. Results: As per comparison Of SAAG with ultrasound in detecting ascites, sensitivity was 36.26%, specificity was 75%, PPV was 84.62%, NPV was 23.68% and accuracy was 44.35%. P Value was 0.299. As per comparison of AFTP with ultrasound in detecting ascites, sensitivity was 33.33%, specificity was 59.34%, PPV was 17.78%, NPV was 77.14% and accuracy was 53.91%. P value was 0.513. Conclusion:SAAG exhibits that patients with ascites fluid possess the basis of portal hypertension. Thus we have come to this conclusion that SAAG can effectively enhance the diagnostic value of ascites fluid tests and therefore its classification can be considered to be a novel standard in the analysis of ascites fluid. Keywords: Diagnostic Accuracy, Ascites Volume, Ascitic Albumin Gradient (SAAG), Ascitic Fluid Total Proteins (AFTP)

scholarly journals Ascitic fluid analysis with special reference to serum ascites cholesterol gradient and serum ascites albumin gradient

2017 ◽  
Vol 5 (2) ◽  
pp. 429 ◽  
Author(s):  
Anand Sankar Sastry ◽  
Subash Ch. Mahapatra ◽  
Vidyasagar Dumpula
Keyword(s):  
Diagnostic Accuracy ◽  
Ascitic Fluid ◽  
Total Protein ◽  
High Sensitivity ◽  
Cost Effective ◽  
Clinical Problem ◽  
Malignant Ascites ◽  
Diagnostic Efficacy ◽  
Fluid Analysis ◽  
Sensitivity Specificity

Background: Ascites being a common clinical problem with a vast spectrum of etiologies, less expensive and widely available biochemical parameters are required to differentiate ascites which can correlate with pathogenesis and pin point towards an etiology with high sensitivity and significant accuracy. Aims of the study were to determine the sensitivity, specificity and diagnostic efficacy of serum ascites albumin Gradient (SAAG) and that of ascitic fluid total protein (AFTP), evaluating their diagnostic role in identifying the etiology of ascites, to determine the diagnostic efficacy of Ascitic fluid cholesterol and serum ascites cholesterol gradient (SACG) in diagnosis of malignant ascites.Methods: In this study, 100 patients of ascitis were evaluated for ascitic fluid total protein, albumin, cholesterol, SAAG and SACG along with ultrasound and other required investigations.Results: Sensitivity, Specificity, and Diagnostic accuracy of SAAG for Portal hypertension were 97%, 85%, 96% respectively, whereas those of AFTP for exudative/transudative ascitis were 78.5%, 66%, 68% respectively. Ascitic fluid cholesterol and Mean SACG were significantly elevated in malignant ascites when compared with Non-Malignant Ascitis with p=0.0001. Similarly with a cut off level of 70mg% and 54 mg%, Ascitic fluid cholesterol and Mean SACG are having diagnostic accuracy of 90% and 93% respectively.Conclusions: SAAG is much more superior to AFTP in differential diagnosis of Ascitis. Ascitic fluid cholesterol and Mean SACG are simple and cost effective methods to separate malignant ascitis from non-malignant causes even in small centres with limited diagnostic facilities.

Tumor Markers (CEA, TPA and CA 19–9) in Urine of Bladder Cancer Patients

1987 ◽  
Vol 2 (2) ◽  
pp. 121-124 ◽  
Author(s):  
Alessandro Tizzani ◽  
Giovanni Cassetta ◽  
Anna Cicigoi ◽  
Paolo Piana ◽  
Antonella Cerchier ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urinary Tract ◽  
Diagnostic Accuracy ◽  
Inflammatory Diseases ◽  
Diagnostic Procedures ◽  
Bladder Tumors ◽  
Cancer Antigen ◽  
Urinary Marker ◽  
Urinary Levels ◽  
Sensitivity Specificity

This study was carried out to evaluate the usefulness of determining urinary levels of carcinoembryogenic antigen (CEA), tissue-polypeptide antigen (TPA), and gastrointestinal cancer antigen (Cal 9-9) in addition to the usual diagnostic procedures for bladder cancer. Sixty-seven patients with transitional bladder cancer, 40 healthy controls and 20 patients with inflammatory diseases of the urinary tract were considered. All urine samples were obtained from patients with intact renal function and no urinary tract infection. TPA and Cal 9-9 urinary levels in patients with G3 bladder tumors were significantly higher than in those with lower graded neoplasms. The sensitivity, specificity, and predictive value of a positive (PV+) or negative (PV–) test and the diagnostic accuracy were also evaluated. Cal 9-9 was the best urinary marker for bladder cancer (sensitivity 71.6%, specificity 91.6%, PV + 90.5%, PV–74.3%, diagnostic accuracy 81%).

scholarly journals Clinicopathological correlation of serum ascites albumin gradient with ascitic fluid total protein in patients of ascites with portal hypertension attending a tertiary care hospital in Eastern Bihar, India

2017 ◽  
Vol 4 (3) ◽  
pp. 842 ◽  
Author(s):  
Shanker Suman ◽  
Divya Jyoti ◽  
Pramod Kumar Agrawal ◽  
Bijoy Kumar Bhattacharya
Keyword(s):  
Portal Hypertension ◽  
Ascitic Fluid ◽  
Total Protein ◽  
Protein Concentration ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Total Protein Concentration ◽  
Provisional Diagnosis

Background: The level of ascitic fluid total protein (AFTP) is used to differentiate between transudative and exudative ascites. Ascites patients having portal hypertension are considered to be transudative in nature. The traditional transudate/exudate system of ascitic fluid classification based on ascitic fluid total protein concentration is sometimes misleading in patients of ascites with portal hypertension. Now a days SAAG (serum ascites albumin gradient) has become more acceptable in differentiating patients presenting with ascites due to portal hypertension. The objective of this prospective study was to correlate serum ascites albumin gradient with ascitic fluid total protein in patients of ascites having portal hypertension.Methods: 100 cases of ascites are selected randomly. All the provisional diagnosis are confirmed with the help of different biochemical, pathological and radiological investigations.Results: SAAG (≥1.1gm/dl) was more sensitive and specific (94% and 90% respectively) than ascitic fluid total protein concentration of <2.5 gm/dl (78% and 50% respectively) in detecting portal hypertension and had higher positive and negative predicative values (97% and 82% respectively) compared to AFTP concentration (85% and 38% respectively).Conclusions: Considering the advantages of measuring the serum-ascites albumin gradient in illuminating the pathogenesis of ascites and the ease with which this test can be done, it is suggested that this parameter should replace the traditional parameter of ascitic fluid total protein level in the routine analysis of ascites fluid and classification of ascites.

scholarly journals The Role of Ascitic Fluid Viscosity in the Differential Diagnosis of Ascites

2010 ◽  
Vol 24 (4) ◽  
pp. 255-259 ◽  
Author(s):  
Huseyin Savas Gokturk ◽  
Mehmet Demir ◽  
Nevin Akcaer Ozturk ◽  
Gulhan Kanat Unler ◽  
Sevsen Kulaksizoglu ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Ascitic Fluid ◽  
Total Protein ◽  
Small Sample ◽  
Fluid Viscosity ◽  
Serum Total Protein ◽  
Bacterial Peritonitis ◽  
The Mean ◽  
Sensitivity Specificity

BACKGROUND: Ascites is defined as the pathological accumulation of fluid in the peritoneal cavity. It is the most common complication of cirrhosis, which is also the most common cause of ascites. Viscosity is a measure of the resistance of a fluid to deform under shear stress. Plasma viscosity is influenced by the concentration of plasma proteins and lipoproteins, with the major contribution from fibrinogen. To our knowledge, the viscosity of ascitic fluid has not yet been studied.OBJECTIVE: To evaluate the role of ascitic fluid viscosity in discriminating between ascites due to portal hypertension-related and nonportal hypertension-related causes, and to compare results with the serum-ascites albumin gradient (SAAG).METHODS: The present study involved 142 patients with ascites presenting with diverse medical problems. Serum total protein, albumin, glucose, lactate dehydrogenase (LDH) levels and complete blood count were obtained for all subjects. Paracentesis was performed routinely on admission and all ascitic fluid samples were evaluated by manual cell count with differential, ascitic fluid culture and biochemistry (total protein, albumin, glucose and LDH). Cultures of ascitic fluid were performed at bedside in all patients using blood culture bottles. Ascitic fluid viscosity was measured in a commercially available cone and plate viscometer.RESULTS: Of the 142 patients studied, 34 (24%) had an SAAG of 11 g/L or less, whereas 108 (76%) had an SAAG of greater than 11 g/L. Sex and mean age did not differ significantly between the two groups (P>0.05). Serum total protein, albumin, glucose, LDH levels, leukocyte count, ascitic fluid glucose levels and ascitic fluid leukocyte counts were similar in both groups, with no statistically significant relationship detected (P>0.05). However, the mean (±SD) ascitic fluid total protein (0.0172±0.1104 g/L versus 0.043±0.011 g/L), albumin (0.0104±0.0064 g/L versus 0.0276±0.0069 g/L) and LDH (102.76±80.95 U/L versus 885.71±199.93 U/L) were found to be higher in patients with an SAAG of 11 g/L or less than in those with an SAAG of greater than 11 g/L (P<0.001). The mean ascitic fluid viscosities were 0.86±0.12 centipoise (cP) and 1.22±0.25 cP in patients with an SAAG greater than 11 g/L and an SAAG of 11 g/L or less, respectively (P<0.001). Although ascitic fluid infection was detected in 35 patients (24.6%) (19 patients with spontaneous bacterial peritonitis, seven patients with culture-negative neutrocytic ascites, three patients with monobacterial non-neutrocytic bacterascites and six patients with secondary bacterial peritonitis), no significant effect on ascitic fluid viscosity was detected. Multiple linear regression analysis revealed that ascitic fluid total protein, albumin and LDH levels were independent predictors of ascitic fluid viscosity (P<0.001). The sensitivity, specificity, and positive and negative predictive values of ascitic fluid viscosity for the discrimination between ascites due to portal hypertension-related and nonportal hypertension-related causes according to the SAAG were determined by receiver operating characteristic analysis. Regarding the cut-off value of 1.03 cP, ascitic fluid viscosity measurement had a high sensitivity, specificity (98% and 80%, respectively), and positive and negative predictive value (79% and 94%, respectively) for the etiological discrimination of ascites.CONCLUSION: The measurement of ascitic fluid viscosity correlates significantly with SAAG values. In view of its simplicity, low cost, small sample volume requirement and allowance for measurement in previously frozen samples, measurement of ascites viscosity could be useful for the accurate and rapid classification of ascites.

scholarly journals Real-world validation of the 2017 McDonald criteria for pediatric MS

2018 ◽  
Vol 6 (2) ◽  
pp. e528 ◽  
Author(s):  
Yu Yi M. Wong ◽  
C. Louk de Mol ◽  
Roos M. van der Vuurst de Vries ◽  
E. Daniëlle van Pelt ◽  
Immy A. Ketelslegers ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Multicenter Study ◽  
Predictive Value ◽  
Acute Disseminated Encephalomyelitis ◽  
Prospective Multicenter Study ◽  
Mcdonald Criteria ◽  
Sensitivity Specificity

ObjectiveTo compare the diagnostic accuracy of the McDonald 2017 vs the McDonald 2010 criteria to predict a second attack of MS (clinically definite MS [CDMS]) at the first attack of acquired demyelinating syndromes (ADS).MethodsOne hundred sixty-four children (aged <18 years) with an incident attack of ADS were included in a prospective multicenter study between June 2006 and December 2016. Brain (and spinal if available) MRI was performed ≤3 months after symptom onset. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were compared at baseline between the 2010 and 2017 criteria.ResultsAmong the 164 patients, 110 patients (67%) presented without encephalopathy (ADS–, female 63%; median age 14.8 years, IQR 11.3–16.1years) and 54 (33%) with encephalopathy (acute disseminated encephalomyelitis [ADEM], female 52%; median age 4.0 years, IQR 2.6–6.1 years). Of the 110 ADS– patients, 52 (47%) were diagnosed with CDMS within a median follow-up of 4.5 years (IQR 2.6–6.7 years). The sensitivity was higher for the 2017 criteria than for the 2010 criteria (83%; 95% CI 67–92, vs 49%; 95% CI 33–65; p < 0.001), but the specificity was lower (73%; 95% CI 59–84 vs 87%; 95% CI 74–94, p = 0.02). At baseline, 48 patients fulfilled the 2017 criteria compared with 27 patients when using the 2010 criteria. The results for children aged <12 years without encephalopathy were similar. In patients with ADEM, 8% fulfilled the 2010 criteria and 10% the 2017 criteria at baseline but no patient fulfilled the criteria for CDMS.ConclusionsThe McDonald 2017 criteria are more sensitive than the McDonald 2010 criteria for predicting CDMS at baseline. These criteria can also be applied in children aged <12 years without encephalopathy but not in children with ADEM.Classification of evidenceThis study provides Class II evidence that in children with ADS, the 2017 McDonald criteria are more sensitive but less specific than the 2010 McDonald criteria for predicting CDMS.

scholarly journals SPONTANEOUS BACTERIAL PERITONITIS

2018 ◽  
Vol 25 (04) ◽  
pp. 589-593
Author(s):  
Umme Aeman Khan ◽  
Hamna Iqbal ◽  
Muhammad Omer Aslam ◽  
Muhammad Ehtisham Saqib ◽  
Hafiz M. Yassen ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Ascitic Fluid ◽  
Neutrophil Count ◽  
Gold Standard ◽  
Spontaneous Bacterial Peritonitis ◽  
Positive Likelihood Ratio ◽  
Bacterial Peritonitis ◽  
Wbc Count ◽  
Sensitivity Specificity ◽  
Study Setting

Objectives: To find out the diagnostic accuracy of ascitic fluid LactateDehydrogenase in diagnosis of Spontaneous bacterial peritonitis using ascitic fluid absoluteneutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard. Study Design:Cross sectional (validation) study. Setting: This study was conducted in department ofMedicine, Madina Teaching Hospital Faisalabad. Duration of Study: 6 months starting afterapproval of synopsis (From:01-06-2016 to 30-11-16). Methodology: 10 ml of ascitic fluidwas withdrawn from these patients, and sent for cytology and biochemistry. Ascitic fluid cellcount, total protein, albumin and LDH wascalculated along with serum albumin and serumLDH. Serum LDH and ascitic fluid LDH was calculated by using Cobas C311 Roche Analyzer,serum/ascitic albumin gradient (SAAG) was calculated by subtracting ascitic albumin fromserum albumin to prove portal hypertension as a cause of ascites. AsciticLDH/serum LDH ratiowas calculated by dividing ascitic LDH by serum LDH.Absolute neutrophil count was derivedfrom total WBC count. Results: In our study, mean age was calculated as 45.37+11.13 years,53.75% (n=43) were male and 46.25% (n=37) were females. Frequency SBP on gold standardwas recorded in 52.5% (n=42). Diagnostic accuracy of ascitic fluid lactate dehydrogenasein diagnosis of spontaneous bacterial peritonitis using ascitic fluid absolute neutrophil countequal to or greater than 250 cells/mm3 as a gold standard was recorded as 82.22%, 85.71%,88.09%, 78.95%, 83.75% for sensitivity, specificity, positive predictive value, negative predictivevalue and accuracy rate, positive likelihood ratio was calculated as 5.75 and 0.21 for negativelikelihood ratio was calculated as 5.75. Conclusion: The diagnostic accuracy of ascitic fluidLactate Dehydrogenase is higher in diagnosis of Spontaneous bacterial peritonitis using asciticfluid absolute neutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard.

scholarly journals Real-Time Elastography in the diagnosis of prostate cancer: a systematic review

2019 ◽  
Vol 21 (3) ◽  
pp. 327
Author(s):  
Yang Zhang ◽  
Zheying Meng ◽  
Yanjun Xu ◽  
Quijie Lu ◽  
Rui Hou ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Real Time ◽  
Diagnostic Odds Ratio ◽  
Cochrane Library ◽  
P Value ◽  
Inclusion Criteria ◽  
Diagnostic Modality ◽  
Sensitivity Specificity ◽  
Group 1

Aim: To evaluate the diagnostic accuracy of real-time elastography as a method for detecting prostate cancer.Material and methods: Relevant studies applying real-time elastography as the diagnostic modality and biopsy as the reference standard, published by March 1, 2018 were retrieved from PubMed, EMBASE, Web of Science and Cochrane Library databases. Two independent reviewers inspected all these articles to confirm the matching of the inclusion criteria. One reviewer with methodological expertise extracted the data from the included studies. Sensitivity, specificity and diagnostic odds ratio (DOR) were used to obtain overall estimates. Randomized effect method, meta-regression and subgroup analysis were performed.Results: Twenty-four studies out of 1156 identified articles met the inclusion criteria. Three groups were set: analysisby patient (Group 1), by core (Group 2), and by image (Group 3) and subgroups set in Group 1. The pooled estimate ofreal-time elastography sensitivity/ specificity/ DOR calculated with the identical P-value 0.00. Within subgroups “Asia” and“PSA>=10 ng/ml”, the pooled sensitivity, specificity and DOR were 0.83, 0.65 (p=0.01, I2=73.40%; p=0.02, I2=69.5%), 0.80, 0.82 (p=0.66, I2=0.00%; p=0.58, I2=0.00%) and 20.2, 8.67 (p=0.09, I2=54.2%; p=0.20, I2=35.5%), respectively. In these three groups, the areas under the SROC curve were 0.7417, 0.9246, and 0.6213 independently.Conclusions: Real-time elastography is a promising, reliable modality for the non-invasive diagnosis of patients with prostate cancer. The diagnostic accuracy of real-time elastography correlates tightly to the presence of higher PSA level and may help avoid unnecessary biopsy. It seems to be a useful tool in systemic biopsy.

Classification of Infant Vocalizations by Untrained Listeners

2019 ◽  
Vol 62 (9) ◽  
pp. 3265-3275
Author(s):  
Heather L. Ramsdell-Hudock ◽  
Anne S. Warlaumont ◽  
Lindsey E. Foss ◽  
Candice Perry
Keyword(s):  
Formal Education ◽  
Additional Insight ◽  
Listener Responses ◽  
Infant Vocalization ◽  
Early Infant ◽  
Infant Vocalizations ◽  
Audio Recordings ◽  
Speech And Language Development ◽  
Insight Into

Purpose To better enable communication among researchers, clinicians, and caregivers, we aimed to assess how untrained listeners classify early infant vocalization types in comparison to terms currently used by researchers and clinicians. Method Listeners were caregivers with no prior formal education in speech and language development. A 1st group of listeners reported on clinician/researcher-classified vowel, squeal, growl, raspberry, whisper, laugh, and cry vocalizations obtained from archived video/audio recordings of 10 infants from 4 through 12 months of age. A list of commonly used terms was generated based on listener responses and the standard research terminology. A 2nd group of listeners was presented with the same vocalizations and asked to select terms from the list that they thought best described the sounds. Results Classifications of the vocalizations by listeners largely overlapped with published categorical descriptors and yielded additional insight into alternate terms commonly used. The biggest discrepancies were found for the vowel category. Conclusion Prior research has shown that caregivers are accurate in identifying canonical babbling, a major prelinguistic vocalization milestone occurring at about 6–7 months of age. This indicates that caregivers are also well attuned to even earlier emerging vocalization types. This supports the value of continuing basic and clinical research on the vocal types infants produce in the 1st months of life and on their potential diagnostic utility, and may also help improve communication between speech-language pathologists and families.

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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