Delirium Screening in the Emergency Department: A Systematic Review and Meta-analysis

Abstract Background: Delirium is a complex syndrome characterized by a disturbance in attention and awareness, with a prevalence of 10-20% in patients admitted to the Emergency Department (ED). Screening tools have been developed to identify delirium in the ED, but their accuracy of screening remains unclear. To address this challenge, we conducted a comprehensive meta-analysis to systematically review the accuracy of delirium screening tools currently being used to assess ED patients.Methods: PubMed, PsycINFO, EMBASE, and the Cochrane Library were searched. Studies involving ED inpatients which compared diagnostic tools with the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria as a reference standard were included. Two reviewers independently screened the studies, extracted data, and assessed the quality of studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 scale. We conducted a conventional meta-analysis for each screening tool. Then we used network meta-analysis method to calculate the relative sensitivity and specificity among the diagnostic tests. The diagnostic accuracies were then ranked through the superiority index.Results: Thirteen studies included six screening tools. The pooled sensitivity and specificity for the Confusion Assessment Method (CAM) were 0.71 and 0.98, and for 4AT (Arousal, Attention, Abbreviated Mental Test 4, Acute change) were 0.83 and 0.93, respectively. The other four tools used were only reported in one or two studies. Their sensitivity ranged from 0.70 to 1.00, and their specificity ranged from 0.64 to 0.99. Moreover, network meta-analysis indicated that the CAM and 4AT had a greater superiority index and a higher diagnostic accuracy.Conclusions: The available data suggested that both the CAM and 4AT can be used as efficient screening tools for the ED patients.

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Performance of Serum Glypican 3 in Diagnosis of Hepatocellular Carcinoma: A meta-analysis

Annals of Hepatology ◽

10.5604/01.3001.0012.2121 ◽

2018 ◽

Vol 17 (5) ◽

pp. 0-10

Author(s):

Dahai Xu ◽

Chang Su ◽

Liang Sun ◽

Yuanyuan Gao ◽

Youjun Li

Keyword(s):

Hepatocellular Carcinoma ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Operating Characteristic ◽

Web Of Science ◽

Meta Analysis ◽

Characteristic Curve ◽

Positive Control ◽

Cochrane Library ◽

Non Invasive

Introduction and aim. Serum glypican-3 (GPC3) has been explored as a non-invasive biomarker of hepatocellular carcinoma (HCC). However, controversy remains on its diagnostic accuracy. Therefore, we aimed to conduct a systematic review and metaanalysis to evaluate the differential diagnostic accuracy of serum GPC3 between HCC and liver cirrhosis (LC) cases. Material and methods. After the strict filtering and screening of studies from NCBI, PUBMED, Clinical Trials, Cochrane library, Embase, Prospero and Web of Science databases, 11 studies were selected. All studies provided the sensitivity and specificity of GPC3 and the alpha-fetoprotein (AFP) in the HCC and LC diagnosis. The sensitivity and specificity, and the area under the receiver operating characteristic curve (AUC) were determined and compared between GPC3 and AFP, which was set as a positive control. Results. Pooled sensitivity (95% CI) and specificity (95% CI) were 0.55 (0.52-0.58) and 0.58 (0.54-0.61) for GPC3, 0.54 (0.51-0.57) and 0.83 (0.80-0.85) for AFP, and 0.85 (0.81-0.89) and 0.79 (0.73-0.84) for GPC3 + AFP, respectively. The AUCs of GPC3, AFP and GPC3 + AFP were 0.7793, 0.7867 and 0.9366, respectively. GPC3 had a nearly similar sensitivity as AFP, while the specificity and AUC of GPC3 was lower than that of AFP. The combination of GPC3 and AFP yielded a better sensitivity and AUC than GPC3 or AFP. Conclusion. Serum GPC3 is inferior to AFP in the differential diagnosis between HCC and LC. However, the combination of GPC3 and AFP exhibited a much better performance.

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Diagnostic accuracy of the Ottawa 3DY and Short Blessed Test to detect cognitive dysfunction in geriatric patients presenting to the emergency department

BMJ Open ◽

10.1136/bmjopen-2017-019652 ◽

2018 ◽

Vol 8 (3) ◽

pp. e019652 ◽

Cited By ~ 10

Author(s):

David Barbic ◽

Brian Kim ◽

Qadeem Salehmohamed ◽

Kate Kemplin ◽

Christopher R Carpenter ◽

...

Keyword(s):

Emergency Department ◽

Inner City ◽

Diagnostic Accuracy ◽

Cognitive Dysfunction ◽

Sensitivity And Specificity ◽

Geriatric Patients ◽

Screening Tools ◽

Common Finding ◽

Rater Reliability ◽

Robust Likelihood

ObjectivesCognitive dysfunction (CD) is a common finding in geriatric patients presenting to the emergency department (ED). Our primary objective was to determine the diagnostic accuracy of the Ottawa 3DY (O3DY) and Short Blessed Test (SBT) as screening tools for the detection of CD in the ED. Our secondary objective was to estimate the inter-rater reliability of these instruments.MethodsWe conducted a prospective cross-sectional comparative study at an inner-city academic medical centre (annual ED visit census 86 000). Patients aged 75 years or greater were evaluated for inclusion, 163 were screened, 150 were deemed eligible and 117 were enrolled. The research team completed the O3DY, SBT and Mini-Mental State Exam (MMSE) for each participant. Descriptive statistics were calculated. Sensitivity and specificity of the O3DY and SBT were calculated in STATA V.11.2 using the MMSE as our criterion standard.ResultsWe enrolled 117 patients from June to November 2016. The median ED length of stay at the time of completion of all tests was 1:40 (IQR 1:34–1:46). The sensitivity of the O3DY was 71.4% (95% CI 47.8 to 95.1), and specificity was 56.3% (46.7–65.9). Sensitivity of the SBT was 85.7% (67.4–99.9) and specificity was 58.3% (48.7–67.8). The receiver operating characteristic area under the curve was calculated for the O3DY (0.51; 95% CI 0.42 to 0.61) and SBT (0.52; 95% CI 0.43 to 0.61) relative to the MMSE. Inter-rater reliability for the O3DY (k=0.64) and SBT (k=0.63) were good.ConclusionIn a cohort of geriatric patients presenting to an inner-city academic ED, the O3DY and SBT tools demonstrate moderate sensitivity and specificity for the detection of CD. Inter-rater reliability for the O3DY and SBT were good. Future research on this topic should attempt to derive and validate ED-specific screening tools, which will hopefully result in more robust likelihood ratios for the screening of CD in ED geriatric patients.

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Alpha-Defensin versus Leukocyte Esterase in Periprosthetic Joint Infection: An Updated Meta-Analysis

BioMed Research International ◽

10.1155/2020/3704285 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14

Author(s):

Zhizhuo Li ◽

Qingyu Zhang ◽

Lijun Shi ◽

Fuqiang Gao ◽

Wei Sun ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Periprosthetic Joint Infection ◽

Data Extraction ◽

Meta Analysis ◽

Joint Infection ◽

Area Under The Curve ◽

Cochrane Library ◽

Systematic Research ◽

High Diagnostic Accuracy

Periprosthetic joint infection (PJI) is a devastating complication after arthroplasty. Prompt establishment of an infection diagnosis is critical but can be very challenging at present. In order to evaluate the diagnostic accuracy of alpha-defensin or leukocyte esterase for PJI, we performed systematic research in PubMed, Embase, and Cochrane Library to retrieve relevant studies. Data extraction and quality assessment were performed by two reviewers independently. A total of thirty-one eligible studies were finally included in the quantitative analysis. The pooled sensitivity and specificity of alpha-defensin (21 studies) for the diagnosis of PJI were 0.89 (95% confidence interval (CI), 0.83 to 0.93) and 0.96 (95% CI, 0.95 to 0.97), respectively. The value of the pooled diagnostic odds ratios (DOR) of alpha-defensin for PJI was 209.14 (95% CI, 97.31 to 449.50), and the area under the curve (AUC) was 0.98 (95% CI, 0.96 to 0.99). The pooled sensitivity and specificity of leukocyte esterase (17 studies) for the diagnosis of PJI were 0.90 (95% CI, 0.84 to 0.95) and 0.96 (95% CI, 0.93 to 0.97), respectively. The value of the DOR of leukocyte esterase for PJI was 203.23 (95% CI, 96.14 to 429.61), and the AUC was 0.98 (95% CI, 0.96 to 0.99). Based on the results of our meta-analysis, we can conclude that alpha-defensin and leukocyte esterase are valuable synovial fluid markers for identifying PJI with comparable high diagnostic accuracy.

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Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers

Age and Ageing ◽

10.1093/ageing/afz144 ◽

2019 ◽

Vol 49 (1) ◽

pp. 130-134

Author(s):

Krishan Yadav ◽

Valérie Boucher ◽

Pierre-Hugues Carmichael ◽

Philippe Voyer ◽

Debra Eagles ◽

...

Keyword(s):

Emergency Department ◽

Sensitivity And Specificity ◽

Primary Outcome ◽

Screening Tool ◽

Confusion Assessment Method ◽

Assessment Method ◽

Multicenter Cohort Study ◽

Delirium Assessment ◽

Lengths Of Stay ◽

History Of

Abstract Background delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. Objectives to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. Design a prospective observational multicenter cohort study. Setting four Quebec EDs. Participants independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation. Measurements eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. Results we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval—CI 69.3–96.2%) and a specificity of 44.3% (95%; CI 38.3–50.4%). Conclusion serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.

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The diagnostic performance of dual energy CT for diagnosing gout: a systematic literature review and meta-analysis

Rheumatology ◽

10.1093/rheumatology/kez180 ◽

2019 ◽

Vol 58 (12) ◽

pp. 2117-2121 ◽

Cited By ~ 10

Author(s):

Mihaela Gamala ◽

Johannes W G Jacobs ◽

Jaap M van Laar

Keyword(s):

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Dual Energy ◽

Disease Stage ◽

Cochrane Library ◽

Dual Energy Ct ◽

Recent Onset ◽

Short Disease Duration ◽

Library Studies

Abstract Objective This study aimed to assess the utility of dual energy CT (DECT) for diagnosing gout. Methods A systematic literature search was performed in PubMed, EMBASE and Cochrane Library. Studies evaluating the utility of DECT for diagnosing gout were included. Reference standards were detection of monosodium urate crystals at SF assessment or a validated set of criteria. The methodological quality of studies was evaluated according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 criteria. Data from person-based and joint-/localization-based evaluations were pooled separately, and subgroup analyses for disease stage/duration and reference standard were performed. Results Ten studies were included; in person-based evaluations, the pooled (95% CI) sensitivity and specificity were 0.81 (0.77, 0.86) and 0.91 (0.85, 0.95), respectively. In joint-based evaluations, they were 0.83 (0.79, 0.86) and 0.88 (0.83, 0.92), respectively. At short disease duration (⩽6 weeks), the pooled (95% CI) sensitivity and specificity at the joint level were 0.55 (0.46, 0.64) and 0.89 (0.84, 0.94), respectively. Conclusion DECT has a high diagnostic accuracy in established gout, but its diagnostic sensitivity is low in subjects with recent onset gout.

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Delirium in Acute Stroke: A Survey of Screening and Diagnostic Practice in Scotland

ISRN Stroke ◽

10.1155/2013/620186 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Gail Carin-Levy ◽

Kath Nicol ◽

Frederike van Wijck ◽

Gillian E. Mead

Keyword(s):

Acute Stroke ◽

Clinical Judgment ◽

Confusion Assessment Method ◽

Assessment Method ◽

Screening Tools ◽

Diagnostic Tools ◽

Free Text ◽

Stroke Patients ◽

Nominal Data ◽

Doctors And Nurses

Aims. To survey the use of delirium screening and diagnostic tools in patients with acute stroke across Scotland and to establish whether doctors and nurses felt the tools used were suitable for stroke patients. Methods. An invitation to participate in a web-based survey was e-mailed to 217 doctors and nurses working in acute stroke across Scotland. Descriptive statistics were used to report nominal data, and content analysis was used to interpret free text responses. Results. Sixty-five responses were logged (30% return rate). 48% of the respondents reported that they routinely screened newly admitted patients for delirium. Following initial screening, 38% reported that they screened for delirium as the need arises. 43% reported using clinical judgment to diagnose delirium, and 32% stated that they combined clinical judgment with a standardised tool. 28% of the clinicians reported that they used the Confusion Assessment Method; however, only 13.5% felt that it was suitable for stroke patients. Conclusions. Screening for delirium is inconsistent in Scottish stroke services, and there is uncertainty regarding the suitability of screening tools with stroke patients. As the importance of early identification of delirium on stroke outcomes is articulated in recent publications, validating a screening tool to detect delirium in acute stroke is recommended.

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The diagnostic accuracy of smartwatches for the detection of cardiac arrhythmia: A systematic review and meta-analysis. (Preprint)

10.2196/preprints.28974 ◽

2021 ◽

Author(s):

Scarlet Nazarian ◽

Kyle Lam ◽

Ara Darzi ◽

Hutan Ashrafian

Keyword(s):

Diagnostic Accuracy ◽

Cardiac Arrhythmia ◽

Cardiac Arrhythmias ◽

Financial Burden ◽

Meta Analysis ◽

Screening Tools ◽

Cochrane Library ◽

Regulatory Standards ◽

Registration Number ◽

Sensitivity Specificity

BACKGROUND A significant morbidity, mortality and financial burden is associated with cardiac rhythm abnormalities. Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. Conventional screening tools are often unsuccessful at detecting AF due to its episodic nature. Smartwatches have gained popularity in recent years as a health screening tool. OBJECTIVE The aim of our study was to systematically review and meta-analyse the diagnostic accuracy of smartwatches in the detection of cardiac arrhythmias. METHODS A comprehensive literature search was undertaken using the databases of EMBASE, Medline and the Cochrane Library. PRISMA guidance was followed. Studies reporting use of a smartwatch for detection of cardiac arrythmia were included. Independent proportion and their differences were calculated and pooled through DerSimonian and Laird random-effects modelling. Quality was assessed using the QUADAS-2 tool. RESULTS A total of 18 studies were analysed, measuring diagnostic accuracy in 424, 371 subjects in total. The overall sensitivity, specificity and accuracy of smartwatches to detect cardiac arrhythmias was 100% (95% CI 0.99-1.00), 95% (95% CI 0.93-0.97) and 97% (95% CI 0.96-0.99), respectively. The pooled PPV and NPV for detecting cardiac arrythmias was 85% 85% (95% CI 0.79-0.90) and 100% (95% CI 1.0-1.0), respectively. CONCLUSIONS This review demonstrates the evolving field of digital disease screening and the increased role of machine learning in healthcare. The current diagnostic accuracy of smartwatch technology for detection of cardiac arrhythmias is high. Whilst the innovative drive of digital devices in healthcare screening will continue to gain momentum, the process of accurate evidence accrual and regulatory standards ready to accept their introduction is strongly needed. CLINICALTRIAL PROSPERO registration number: CRD42020213237

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The diagnostic performance of CESM and CE-MRI in evaluating the pathological response to neoadjuvant therapy in breast cancer: a systematic review and meta-analysis

British Journal of Radiology ◽

10.1259/bjr.20200301 ◽

2020 ◽

Vol 93 (1112) ◽

pp. 20200301

Author(s):

Sudan Tang ◽

Chunhong Xiang ◽

Quan Yang

Keyword(s):

Breast Cancer ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Treatment Strategies ◽

Pathological Response ◽

Cochrane Library ◽

Excellent Performance ◽

Contrast Enhanced ◽

Sensitivity Specificity

Objectives: Neoadjuvant chemotherapy (NAC) is an important method for breast cancer treatment. By monitoring its pathological response, the selection of clinical treatment strategies can be guided. In this study, the meta-analysis was used to compare the accuracy of contrast-enhanced MRI (CE-MRI) and contrast-enhanced spectral mammography (CESM) in detecting the pathological response of NAC. Methods: Literatures associated to CE-MRI and CESM in the evaluation of pathological response of NAC were searched from PubMed, Cochrane Library, web of science, and EMBASE databases. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the quality of studies. Pooled sensitivity, specificity, and the area under the SROC curve were calculated to evaluate the diagnostic accuracy of CE-MRI and CESM in monitoring the pathological response of NAC. Results: There were 24 studies involved, 18 of which only underwent CE-MRI examination, three of which only underwent CESM examination, and three of which underwent both CE-MRI and CESM examination. The pooled sensitivity and specificity of CE-MRI were 0.77 (95%CI, 0.67–0.84) and 0.82 (95%CI, 0.73–0.89), respectively. The pooled sensitivity and specificity of CESM were 0.83 (95%CI, 0.66–0.93) and 0.82 (95%CI, 0.68–0.91), respectively. The AUCs of SROC curve for CE-MRI and CESM were 0.86 and 0.89, respectively. Conclusions: Compared to CE-MRI, CESM has equal specificity, greater sensitivity and excellent performance, which may have a brighter prospect in evaluating the pathological response of breast cancer to NAC. Advances in knowledge: CESM showed equal specificity, greater sensitivity, and excellent performance than CE-MRI.

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The Diagnostic Value of LncRNAs for Bladder Cancer: A Meta-Analysis

10.21203/rs.3.rs-554834/v1 ◽

2021 ◽

Author(s):

Yuan Chen ◽

Faiza Naz ◽

Shi Fu ◽

Mengran Shi ◽

Haihao Li ◽

...

Keyword(s):

Bladder Cancer ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Odds Ratio ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Diagnostic Value ◽

Cochrane Library

Abstract Background: In recent years, qualitative and quantitative analysis of LncRNA has been reported as a potential method for early diagnosis of bladder cancer, but the results from each research are insufficient and not completely consistent. This meta-analysis aims to evaluate the diagnostic value of LncRNA for BC.Methods: We conducted a diagnostic meta-analysis and the diagnostic significance of LncRNA in blood, urine and tumor tissues was discussed. We searched the PUBMED, EMABASE, and Cochrane Library until June 2020. The current meta-analysis was performed using Review Manager 5.2, Stata 16.0 and Meta-Disc 1.4 software. Results: A total of 18 researches involving early and/or advanced bladder cancer were finally included. The overall diagnostic accuracy was measured as follows: pooled sensitivity and specificity were 0.72 (95%CI:0.70, 0.73) and 0.76 (95%CI: 0.75, 0.78). Pooled positive likelihood ratio and negative likelihood ratio were 3.09 (95%CI: 2.66, 3.58) and 0.37 (95%CI: 0.33, 0.42). Combined diagnostic odds ratio was 9.43 (95%CI: 7.30, 12.20). A high diagnostic accuracy was demonstrated by the summary receiver operating characteristic curve, with area under the curve of 0.82 (95%CI: 0.78, 0.85). UCA1 and H19 had the best diagnostic effect, their diagnostic sensitivity and specificity were 80%, 79% and 79%, 73% respectively, the combined diagnostic odds ratio was 16.85 and 12.67 respectively.Conclusions: This meta-analysis suggests that LncRNA have great potential in the diagnosis of bladder cancer, UCA1 and H19 had the best diagnostic effect. LncRNA panel is the future development direction in the diagnosis of bladder cancer. However, larger sample researches are needed to further confirm our conclusion.

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Diagnostic Accuracy of HPV Detection in Patients with Oropharyngeal Squamous Cell Carcinomas: A Systematic Review and Meta-Analysis

Viruses ◽

10.3390/v13091692 ◽

2021 ◽

Vol 13 (9) ◽

pp. 1692

Author(s):

Kathrine Kronberg Jakobsen ◽

Amanda-Louise Fenger Carlander ◽

Simone Kloch Bendtsen ◽

Martin Garset-Zamani ◽

Charlotte Duch Lynggaard ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Detection Method ◽

Meta Analysis ◽

Squamous Cell Carcinomas ◽

Tumour Tissue ◽

Detection Methods ◽

Cochrane Library ◽

Blood Samples ◽

The Cochrane Library

The aim of the study was to evaluate the diagnostic accuracy of Human Papillomavirus (HPV) techniques in oropharyngeal cancer. PubMed, EMBASE, the Cochrane Library and clinicaltrials.org were systematically searched for studies reporting methods of HPV detection. Primary outcomes were sensitivity and specificity of HPV detection. In this case, 27 studies were included (n = 5488, 41.6% HPV+). In this case, 13 studies evaluated HPV detection in tumour tissue, nine studies examined HPV detection in blood samples and five studies evaluated HPV detection in oral samples. Accuracy of HPV detection in tumour tissue was high for all detection methods, with pooled sensitivity ranging from 81.1% (95% CI 71.9–87.8) to 93.1% (95% CI 87.4–96.4) and specificity ranging from 81.1% (95% CI 71.9–87.8) to 94.9% (95% CI 79.1–98.9) depending on detection methods. Overall accuracy of HPV detection in blood samples revealed a sensitivity of 81.4% (95% CI 62.9–91.9) and a specificity of 94.8% (95% CI 91.4–96.9). In oral samples pooled sensitivity and specificity were lower (77.0% (95% CI 68.8–83.6) and 74.0% (95% CI 58.0–85.4)). In conclusion, we found an overall high accuracy for HPV detection in tumour tissue regardless of the HPV detection method used. HPV detection in blood samples may provide a promising new way of HPV detection.

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