scholarly journals Performance of Fetal Medicine Foundation Software for Pre-Eclampsia Prediction Upon Marker Customization: Cross-Sectional Study (Preprint)

2019 ◽  
Author(s):  
Karina Bilda De Castro Rezende ◽  
Antonio José Ledo Alves Cunha ◽  
Joffre Amim Jr ◽  
Wescule De Moraes Oliveira ◽  
Maria Eduarda Belloti Leão ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive ◽  
False Positive Rate ◽  
Area Under The Curve ◽  
Screening Tests ◽  
Risk Scores ◽  
Cross Sectional ◽  
Fetal Medicine ◽  
Maternal Characteristics ◽  
Positive Rate

BACKGROUND FMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting. OBJECTIVE This study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity. METHODS This was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test. RESULTS A total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95% CI 12.5-16.0) and 182 out of 1531 cases (11.88%; 95% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate. CONCLUSIONS We conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests.

scholarly journals Performance of Fetal Medicine Foundation Software for Pre-Eclampsia Prediction Upon Marker Customization: Cross-Sectional Study

10.2196/14738 ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. e14738 ◽  
Author(s):  
Karina Bilda De Castro Rezende ◽  
Antonio José Ledo Alves Cunha ◽  
Joffre Amim Jr ◽  
Wescule De Moraes Oliveira ◽  
Maria Eduarda Belloti Leão ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive ◽  
False Positive Rate ◽  
Area Under The Curve ◽  
Screening Tests ◽  
Risk Scores ◽  
Cross Sectional ◽  
Fetal Medicine ◽  
Maternal Characteristics ◽  
Positive Rate

Background FMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting. Objective This study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity. Methods This was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test. Results A total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95% CI 12.5-16.0) and 182 out of 1531 cases (11.88%; 95% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate. Conclusions We conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests.

Screening for Lead Poisoning in an Urban Pediatric Clinic Using Samples Obtained by Fingerstick

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 174-179
Author(s):  
David J. Schonfeld ◽  
Mark R. Cullen ◽  
Petrie M. Rainey ◽  
Anne T. Berg ◽  
David R. Brown ◽  
...  
Keyword(s):  
Lead Poisoning ◽  
False Positive ◽  
Lead Concentration ◽  
Capillary Tube ◽  
Graphite Furnace ◽  
False Positive Rate ◽  
Screening Tests ◽  
Zinc Protoporphyrin ◽  
Pediatric Clinic ◽  
Positive Rate

Objective. To assess the false positive rate of blood (BPb) determinations on sample obtained by fingerstick from children screened in an urban clinic. Method. From a single fingerstick (N = 1573), blood was collected in a capillary tube for determining lead concentration (CPb) by graphite furnace and an additional sample was absorbed onto a filter paper for determining lead concentration (FPb) by atomic absorption spectrophotometry with Delves cup. Zinc protoporphyrin (ZPP) was measured immediately and a confirmatory venous lead (VPb) specimen was obtained at the same visit if the ZPP was ≥35 µg/dL (0.6 µmol/L); children with either a CPb or FPb ≥15 µg/dL (0.7 µmol/L) were later recalled for determining VPb. Results. For the 172 children who had a VPb on the same day as the screening tests, the false positive rates (95% confidence intervals) at a lead threshold of 15 µg/dL (0.7 µmol/L) were: CPb, 13.5% (6.7-20.3); FPb, 19.1% (11.8-26.4). Analyses using all 679 screens with a paired venous specimen (mean delay between screen and venous testing = 30 days) yielded much higher false positive rates (CPb, 31.3%; FPb, 46.0%). Conclusions. Screening for lead poisoning is feasible within an urban pediatric clinic by direct measurement of lead concentration in blood samples obtained by fingerstick. The false positive rate that can be obtained is acceptable given the precision of measuring BPb concentration. Practitioners using a staged screening protocol may incorrectly attribute a higher false positive rate to the screening tests, when much of the error may be due to the temporal variability of BPb resulting from both biologic variability in BPb concentration and intermittent exposures.

Properly collected plasma metanephrines excludes PPGL after false positive screening tests

2021 ◽  
Author(s):  
Gregory A Kline ◽  
Jessica Boyd ◽  
Brenda Polzin ◽  
Adrian Harvey ◽  
Janice L Pasieka ◽  
...  
Keyword(s):  
False Positive ◽  
Adrenal Mass ◽  
Chart Review ◽  
False Positive Rate ◽  
Total Positivity ◽  
Screening Tests ◽  
Positive Rate ◽  
Plasma Metanephrines ◽  
Positive Results ◽  
Urine Metanephrines

Abstract Context False positive results are common for pheochromocytoma/paraganglioma(PPGL) real-world screening. Objective Determine the correlation between screening urine and seated plasma metanephrines in outpatients where PPGL was absent, compared to meticulously prepared and supine-collected plasma metanephrines with age-adjusted references. Design Retrospective cohort study Setting Databases from a single-provider provincial laboratory(2012-2018), a validated PPGL registry and a manual chart review from a specialized endocrine testing unit. Patients PPGL registry data excluded known PPGL cases from the laboratory database. Outpatients having both urine and plasma metanephrines <90 days apart. Methods The correlation between urine and seated plasma measures along with the total positivity rate. All cases of plasma metanephrines drawn in the endocrine unit were reviewed for test indication and test positivity rate. Results There were 810 non-PPGL pairs of urine and plasma metanephrines in the laboratory database; 46.1% of urine metanephrines were reported high. Of seated outpatient plasma metanephrines drawn a median of 5.9 days later, 19.2% were also high (r=0.33 and 0.50 for normetanephrine and metanephrine, respectively). In contrast, the meticulously prepared and supine collected patients(n=139, 51% prior high urine metanephrines) had <3% rate of abnormal high results in patients without known PPGL/adrenal mass. Conclusions There was a poor-to-moderate correlation between urine and seated plasma metanephrines. Up to 20% of those with high urine measures also had high seated plasma metanephrines in the absence of PPGL. Properly prepared and collected supine plasma metanephrines had a false positive rate of <3% in the absence of known PPGL/adrenal mass.

scholarly journals A prospective clinical trial to compare the performance of dried blood spots prenatal screening for Down’s syndrome with conventional non-invasive testing technology

2017 ◽  
Vol 242 (5) ◽  
pp. 547-553
Author(s):  
Huiying Hu ◽  
Yulin Jiang ◽  
Minghui Zhang ◽  
Shanying Liu ◽  
Na Hao ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive ◽  
False Positive Rate ◽  
Down's Syndrome ◽  
Down’S Syndrome ◽  
Dried Blood Spots ◽  
High Risk Women ◽  
Secondary Screening ◽  
Serum Screening ◽  
Positive Rate

To evaluate, side by side, the efficiency of dried blood spots (DBSs) against serum screening for Down’s syndrome, and then, to construct a two-tier strategy by topping up the fetal cell-free DNA (cfDNA) secondary screening over the high-risk women marked by the primary blood testing to build a practical screening tactic to identify fetal Down’s syndrome. One thousand eight hundred and thirty-seven low-risk Chinese women, with singleton pregnancy, were enrolled for the study. Alpha-fetoprotein and free beta human chorionic gonadotropin were measured for the serum as well as for the parallel DBS samples. Partial high-risk pregnant women identified by primary blood testing (n = 38) were also subject to the secondary cfDNA screening. Diagnostic amniocentesis was utilized to confirm the screening results. The true positive rate for Down’s syndrome detection was 100% for both blood screening methods; however, the false-positive rate was 3.0% for DBS and 4.0% for serum screening, respectively. DBS correlated well with serum screening on Down’s syndrome detection. Three out of 38 primary high-risk women displayed chromosomal abnormalities by cfDNA analysis, which were confirmed by amniocentesis. Either the true detection rate or the false-positive rate for Down’s syndrome between DBS and the serum test is comparable. In addition, blood primary screening aligned with secondary cfDNA analysis, a “before and after” two-tier screening strategy, can massively decrease the false-positive rate, which, then, dramatically reduces the demand for invasive diagnostic operation. Impact statement Children born with Down’s syndrome display a wide range of mental and physical disability. Currently, there is no effective treatment to ease the burden and anxiety of the Down’s syndrome family and the surrounding society. This study is to evaluate the efficiency of dried blood spots against serum screening for Down’s syndrome and to construct a two-tier strategy by topping up the fetal cell-free DNA (cfDNA) secondary screening over the high-risk women marked by the primary blood testing to build a practical screening tactic to identify fetal Down’s syndrome. Results demonstrate that fetal cfDNA can significantly reduce false-positive rate close to none while distinguishing all true positives. Thus, we recommend that fetal cfDNA analysis to be utilized as a secondary screening tool atop of the primary blood protein screening to further minimize the capacity of undesirable invasive diagnostic operations.

Second Trimester Screening of Preeclampsia Using Maternal Characteristics and Uterine and Ophthalmic Artery Doppler

2016 ◽  
Vol 39 (02) ◽  
pp. 190-197 ◽  
Author(s):  
Paulo Praciano de Souza ◽  
Júlio Gurgel Alves ◽  
Sammya Bezerra Maia e Holanda Moura ◽  
Edward Araujo Júnior ◽  
Wellington Martins ◽  
...  
Keyword(s):  
Pregnant Women ◽  
False Positive ◽  
Ophthalmic Artery ◽  
False Positive Rate ◽  
Categorical Variables ◽  
Second Trimester ◽  
Maternal Characteristics ◽  
Maternal Risk ◽  
Second Trimester Screening ◽  
Positive Rate

Abstract Purpose To establish the performance of a multi-parametric test including maternal risk factors and maternal uterine and ophthalmic artery Doppler in the second trimester of pregnancy for the prediction of preeclampsia (PE). Materials and Methods We performed a prospective observational cohort study with pregnant women who underwent a second trimester morphology scan. Maternal uterine and ophthalmic artery Doppler examinations were performed in 415 singleton pregnancies between 18 and 23 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to the time of discharge post-delivery. The control and PE groups were compared to continuous variables using the Kruskal-Wallis test and to categorical variables using the Chi-square and Fisher exact tests. Univariate and multivariate logistic regression analyses were performed to determine the best model for the prediction of PE. Results 40 (9.6 %) pregnant women developed PE. We observed significant differences in the body mass index (BMI) (p < 0.001), parity (p < 0.001), mean arterial pressure (MAP) (p < 0.001), and pulsatility index (PI) of uterine artery Doppler (p < 0.001) between PE and control groups. The best model for the prediction of PE included maternal characteristics, MAP, maternal uterine and ophthalmic artery Doppler with area under receiver operating characteristics (ROC) curve of 0.710 (95 % confidence interval, 613 – 0.807) with a sensitivity of 45 % to a false-positive rate of 10 % and 35 % to a false-positive rate of 5 %. Conclusion Maternal ophthalmic artery Doppler did not promote a significant increase in the PE detection rate during the second trimester scan.

scholarly journals Voxel-level Classification of Prostate Cancer Using a Four-Compartment Restriction Spectrum Imaging Model

2020 ◽  
Author(s):  
Christine H Feng ◽  
Christopher Charles Conlin ◽  
Kanha Batra ◽  
Ana Rodriguez-Soto ◽  
Roshan Karunamuni ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
False Positive ◽  
False Positive Rate ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Imaging Data ◽  
Pelvic Mri ◽  
Positive Rate ◽  
Model Coefficient ◽  
Spectrum Imaging

Purpose: Diffusion MRI is integral to detection of prostate cancer (PCa), but conventional ADC cannot capture the complexity of prostate tissues. A four-compartment restriction spectrum imaging (RSI4) model was recently found to optimally characterize pelvic diffusion signals, and the model coefficient for the slowest diffusion compartment, RSI4-C1, yielded greatest tumor conspicuity. In this study, RSI4-C1 was evaluated as a quantitative voxel-level classifier of PCa. Methods: This was a retrospective analysis of 46 men who underwent an expanded-acquisition pelvic MRI for suspected PCa. Twenty-three men had no detectable cancer on biopsy or clinical follow-up; the other 23 had biopsy-proven PCa corresponding to a lesion on MRI (PI-RADS category 3-5). High-confidence cancer voxels were delineated by expert consensus, using imaging data and biopsy results. The entire prostate was considered benign in patients with no detectable cancer. Diffusion images were used to calculate RSI4-C1 and conventional ADC. Voxel-level discrimination of PCa from benign prostate tissue was assessed via receiver operating characteristic (ROC) curves generated by bootstrapping with patient-level case resampling. Specifically, we compared RSI4-C1 and conventional ADC on mean (and 95% CI) for two metrics: area under the curve (AUC) and false-positive rate for a sensitivity of 90% (FPR90). Classifier images were also compared. Results: RSI4-C1 outperformed conventional ADC, with greater AUC [0.977 (0.951-0.991) vs. 0.921 (0.873-0.949)] and lower FPR90 [0.033 (0.009-0.083) vs. 0.201 (0.131-0.300)]. Conclusion: RSI4-C1 yielded a quantitative, voxel-level classifier of PCa that was superior to conventional ADC. RSI classifier images with a low false-positive rate might improve PCa detection.

scholarly journals A population approach using cholesterol imputation to identify adults with high cardiovascular risk: a report from AHRQ’s EvidenceNow initiative

2018 ◽  
Vol 26 (2) ◽  
pp. 155-158
Author(s):  
Samuel Cykert ◽  
Darren A DeWalt ◽  
Bryan J Weiner ◽  
Michael Pignone ◽  
Jason Fine ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive Rate ◽  
Hdl Cholesterol ◽  
Risk Scores ◽  
Risk Equation ◽  
Positive Rate ◽  
Small Primary ◽  
Ascvd Risk ◽  
Conservative Estimation ◽  
Primary Care Practices

Abstract Objective: Large practice networks have access to EHR data that can be used to drive important improvements in population health. However, missing data often limit improvement efforts. Our goal was to determine the proportion of patients in a cohort of small primary care practices who lacked cholesterol data to calculate ASCVD risk scores and then gauge the extent that imputation can accurately identify individuals already at high risk. 219 practices enrolled. Patients between the ages of 40 and 79 years qualified for risk calculation. For patients who lacked cholesterol data, we measured the effect of employing a conservative estimation strategy using a total cholesterol of 170 mg/dl and HDL-cholesterol of 50 mg/dl in the ASCVD risk equation to identify patients with ≥ 10%, 10-year ASCVD risk who were eligible for risk reduction interventions then compared this to a rigorous formal imputation methodology. 345 440 patients, average age 58 years, qualified for risk scores. 108 515 patients were missing cholesterol information. Using the “good value” estimation methodology, 40 565 had risk scores ≥ 10% compared to 43 205 using formal imputation. However, the latter strategy yielded a lower specificity and higher false positive rate. Estimates using either strategy achieved ASCVD risk stratification quickly and accurately identified high risk patients who could benefit from intervention.

Comparison of Vestibulo-Ocular and Vestibulospinal Screening Tests

1981 ◽  
Vol 89 (5) ◽  
pp. 811-817 ◽  
Author(s):  
F. Owen Black ◽  
Conrad Wall
Keyword(s):  
False Positive ◽  
False Positive Rate ◽  
The Other ◽  
Screening Tests ◽  
Caloric Test ◽  
Positional Nystagmus ◽  
Vestibular Disorder ◽  
Positive Rate ◽  
Peripheral Vestibular Disorder ◽  
Caloric Tests

A comparison of a newly developed vestibulospinal screening test and two vestibulo-ocular screening tests (caloric and rotation) was performed on two groups of patients, one with Meniere's disease (MD) the other with benign paroxysmal positional nystagmus (BPPN) and vertigo. Vestibulospinal screening tests were slightly more sensitive (not statistically significant) than caloric tests for detection of a peripheral vestibular disorder. Caloric, rotation, and vestibulospinal screening tests were specific neither for MD nor BPPN groups. The caloric test false-positive rate for the involved ear was unacceptably high for the BPPN group. The rotation test false-positive rate was the highest of the three tests for both groups. The vestibulospinal test combined with either the caloric or the rotational tests increased the sensitivity for detection of a peripheral vestibular disturbance, particularly for the MD patients.

scholarly journals Integrated Screening for Chromosomal Anomalies: Strategies in Developing Countries

2011 ◽  
Vol 5 (2) ◽  
pp. 133-136
Author(s):  
Narendra Malhotra ◽  
Jai Prakash Rao
Keyword(s):  
False Positive ◽  
Detection Rate ◽  
False Positive Rate ◽  
Screening Tests ◽  
Chromosomal Anomalies ◽  
Ultrasound Screening ◽  
Embryo Viability ◽  
High Detection Rate ◽  
Genetic Syndrome ◽  
Positive Rate

ABSTRACT Ultrasound screening has advantages over maternal serum screening. These include confirmation of embryo viability, accurate assessment of gestational age, early diagnosis of multiple pregnancies and identification of chorionicity, the detection of major structural abnormalities, major defects of the heart and great arteries, skeletal dysplasias and genetic syndrome and measurement of NT thickness in assessing the risk for Down's syndrome. Nuchal translucency (NT) has emerged as the most sensitive ultrasound marker for detection of chromosomal anomalies in the first trimester. However, the use of ultrasound in routine screening still faces problems with reliability and quality control. Combination of maternal age, NT and first and biochemical second-trimester markers is known as the integrated test. A major goal of screening tests is to achieve high detection rate and low false-positive rate at a low cost. The integrated test best meets these criteria. It could achieve a detection rate of 85% for a false-positive rate of 1.2%. It has a much better positive predictive value and, therefore, fewer amniocentesis and fewer losses of normal fetuses. Only screen-positive cases could be taken for invasive testing.

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