scholarly journals Surveillance of atypical femoral fractures in a nationwide fracture register

2022 ◽  
Vol 93 ◽  
pp. 229-233
Author(s):  
Hans Peter Bögl ◽  
Georg Zdolsek ◽  
Lukas Barnisin ◽  
Michael Möller ◽  
Jörg Schilcher

Background and purpose — To continuously assess the incidence of atypical femoral fractures (AFFs) in the population is important, to allow the evaluation of the risks and benefits associated with osteoporosis treatment. Therefore, we investigated the possibility to use the Swedish Fracture Register (SFR) as a surveillance tool for AFFs in the population and to explore means of improvement. Patients and methods — All AFF registrations in the SFR from January 1, 2015 to December 31, 2018 were enrolled in the study. For these patients, radiographs were obtained and combined with radiographs from 176 patients with normal femoral fractures, to form the study cohort. All images were reviewed and classified into AFFs or normal femur fractures by 2 experts in the field (gold-standard classification) and 1 orthopedic resident educated on the specific radiographic features of AFF (educated-user classification). Furthermore, we estimated the incidence rate of AFFs in the population captured by the register through comparison with a previous cohort and calculated the positive predictive value (PPV) and, where possible, the inter-observer agreement (Cohen’s kappa) between the different classifications. Results — Of the 178 available patients with AFF in the SFR, 104 patients were classified as AFF using the goldstandard classification, and 89 using the educated-user classification. The PPV increased from 0.58 in the SFR classification to 0.93 in the educated-user classification. The interobserver agreement between the gold-standard classification and the educated-user classification was 0.81. Interpretation — With a positive predictive value of 0.58 the Swedish Fracture Register outperforms radiology reports and reports to the Swedish Medical Products Agency on adverse drug reactions as a diagnostic tool to identify atypical femoral fractures.

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Malena Bergvall ◽  
Carl Bergdahl ◽  
Carl Ekholm ◽  
David Wennergren

Abstract Background Distal radial fractures (DRF) are one of the most common fractures with a small peak in incidence among young males and an increasing incidence with age among women. The reliable classification of fractures is important, as classification provides a framework for communicating effectively on clinical cases. Fracture classification is also a prerequisite for data collection in national quality registers and for clinical research. Since its inception in 2011, the Swedish Fracture Register (SFR) has collected data on more than 490,000 fractures. The attending physician classifies the fracture according to the AO/OTA classification upon registration in the SFR. Previous studies regarding the classification of distal radial fractures (DRF) have shown difficulties in inter- and intra-observer agreement. This study aims to assess the accuracy of the registration of DRF in adults in the SFR as it is carried out in clinical practice. Methods A reference group of three experienced orthopaedic trauma surgeons classified 128 DRFs, randomly retrieved from the SFR, at two classification sessions 6 weeks apart. The classification the reference group agreed on was regarded as the gold standard classification for each fracture. The accuracy of the classification in the SFR was defined as the agreement between the gold standard classification and the classification in the SFR. Inter- and intra-observer agreement was evaluated and the degree of agreement was calculated as Cohen’s kappa. Results The accuracy of the classification of DRF in the SFR was kappa = 0.41 (0.31–0.51) for the AO/OTA subgroup/group and kappa = 0.48 (0.36–0.61) for the AO/OTA type. This corresponds to moderate agreement. Inter-observer agreement ranged from kappa 0.22–0.48 for the AO/OTA subgroup/group and kappa 0.48–0.76 for the AO/OTA type. Intra-observer agreement ranged from kappa 0.52–0.70 for the AO/OTA subgroup/group and kappa 0.71–0.76 for the AO/OTA type. Conclusions The study shows moderate accuracy in the classification of DRF in the SFR. Although the degree of accuracy for DRF appears to be lower than for other fracture locations, the accuracy shown in the current study is similar to that in previous studies of DRF.


2009 ◽  
Vol 25 (5) ◽  
pp. 1017-1024 ◽  
Author(s):  
Carolina Castro Martins ◽  
Loliza Chalub ◽  
Ynara Bosco Lima-Arsati ◽  
Isabela Almeida Pordeus ◽  
Saul Martins Paiva

The aim of this study was to assess agreement in the diagnosis of dental fluorosis performed by a standardized digital photographic method and a clinical examination (gold standard). 49 children (aged 7-9 years) were clinically evaluated by a trained examiner for the assessment of dental fluorosis. Central incisors were evaluated for the presence or absence of dental fluorosis and were photographed with a digital camera. Photographs were presented to three pediatric dentists, who examined the images. Data were analyzed using Cohen's kappa and validity values. Agreement in the diagnosis performed by the photographic method and clinical examination was good (0.67) and accuracy was 83.7%. The prevalence of dental fluorosis was reported to be higher in the clinical examination (49%) compared with the photographic method (36.7%). The photographic method presented higher specificity (96%) than sensitivity (70.8%), a positive predictive value (PPV) of 94.4% and a negative predictive value (NPV) of 77.4%. The diagnosis of dental fluorosis performed using the photographic method presented high specificity and PPV, which indicates that the method is reproducible and reliable for recording dental fluorosis.


Author(s):  
Sondipon Biswas ◽  
Naman Kanodia ◽  
Rajat Tak ◽  
Siddharth Agrawal ◽  
Kiran Shankar Roy

<p class="abstract"><strong>Background:</strong> Shoulder pathologies can cause significant pain, discomfort, and affect the activity of daily living. The aim of this study was to compare the efficacy of clinical examination, ultrasound, magnetic resonance imaging (MRI) with shoulder arthroscopy in diagnosing various shoulder pathologies, considering shoulder arthroscopy as the gold standard tool.</p><p class="abstract"><strong>Methods:</strong> This was a prospective, comparative study conducted over 35 patients, between 18-75 years of age presenting with chronic shoulder pain or instability of more than 2 months duration. All patients were examined clinically, followed by high resolution ultrasound, MRI, arthroscopy of the affected shoulder.<strong></strong></p><p class="abstract"><strong>Results:</strong> The sensitivity and specificity of ultrasonography (USG) for diagnosing full thickness tear was 100% each and for MRI was 88% and 100% respectively. For subacromial impingement USG had sensitivity of 66.67%, specificity of 94.12%, positive predictive value of 50% and negative predictive value of 88.89%. For rotator cuff tear USG had sensitivity of 92.86%, specificity of 50%, positive predictive value of 81.25% and negative predictive value of 75% considering shoulder arthroscopy as gold standard.</p><p class="abstract"><strong>Conclusions:</strong> USG and MRI both are sensitive techniques for diagnosing of rotator cuff pathologies. USG has high accuracy in diagnosing partial thickness tears as compare to MRI. MRI proved to be superior in estimation of site and extent of tear. Considering shoulder arthroscopy as gold standard, it can be reserved for patients with suspicious of USG/MRI findings or those who may need surgical intervention simultaneously.</p>


2007 ◽  
Vol 136 (2) ◽  
pp. 232-240 ◽  
Author(s):  
S. A. SKULL ◽  
R. M. ANDREWS ◽  
G. B. BYRNES ◽  
D. A. CAMPBELL ◽  
T. M. NOLAN ◽  
...  

SUMMARYThis study examines the validity of using ICD-10 codes to identify hospitalized pneumonia cases. Using a case-cohort design, subjects were randomly selected from monthly cohorts of patients aged ⩾65 years discharged from April 2000 to March 2002 from two large tertiary Australian hospitals. Cases had ICD-10-AM codes J10–J18 (pneumonia); the cohort sample was randomly selected from all discharges, frequency matched to cases by month. Codes were validated against three comparators: medical record notation of pneumonia, chest radiograph (CXR) report and both. Notation of pneumonia was determined for 5098/5101 eligible patients, and CXR reports reviewed for 3349/3464 (97%) patients with a CXR. Coding performed best against notation of pneumonia: kappa 0·95, sensitivity 97·8% (95% CI 97·1–98·3), specificity 96·9% (95% CI 96·2–97·5), positive predictive value (PPV) 96·2% (95% CI 95·4–97·0) and negative predictive value (NPV) 98·2% (95% CI 97·6–98·6). When medical record notation of pneumonia is used as the standard, ICD-10 codes are a valid method for retrospective ascertainment of hospitalized pneumonia cases and appear superior to use of complexes of symptoms and signs, or radiology reports.


Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Marie Luby ◽  
Jennifer Hong ◽  
José G Merino ◽  
John K Lynch ◽  
Amie W Hsia ◽  
...  

Objectives: In the clinical setting, the extent of mismatch on MRI is frequently assessed with an approximate “XYZ/2” method but the agreement with the “gold standard” planimetric volume and the “visual evaluation” methods are not known. In a published study, we established that the visual evaluation and planimetric methods are equivalent as far as mismatch classification. The objectives of this study were to quantify the agreement of the approximate method with the “gold standard” and “visual evaluation” methods and to compare the mismatch classification results. Methods: Patients were selected from the Lesion Evolution of Stroke and Ischemia On Neuroimaging (LESION) database if they: had an acute ischemic stroke, were treated with intravenous rt-PA only, and had a pre-treatment MRI with evaluable maps including trace or isotropic b1000 DWI and MTT images. A trained rater viewed the images on the PACS, placed the two perpendicular linear measurements, “X” and “Y”, on the slices with the largest DWI and MTT lesion areas, and then used a “XYZ/2” formula where “Z” was the product of the slice thickness and the total number of slices containing the lesion. A separate expert rater measured the planimetric volumes on a slice-by-slice basis with a semiautomated segmentation tool followed by manual editing. Expert readers evaluated the MRI scans for the presence of qualitative mismatch. The expert readers were not the trained reader that performed the approximate volume measurements. Quantitative mismatch was considered present if MTT volume - DWI volume ≥50 ml. Mismatch classifications using the ≥ 50 ml definition were compared by constructing contingency tables. Results: A total of 194 patients met the study criteria and had median DWI and MTT planimetric volumes of 13.06 ml and 99.27 ml respectively. For both the DWI (n=170) and MTT (n=164), 94% of the measurements were within two standard deviations of the difference between the planimetric and approximate volume measurements. Comparing the planimetric and approximate volume measurements, the Spearman correlation coefficients were 0.855 and 0.886 for the DWI and MTT measurements respectively (p<0.01). Compared to the planimetric method, the approximate “XYZ/2” method had a high sensitivity (0.91), specificity (0.80), accuracy (0.86) and positive predictive value (0.85) to detect mismatch using the ≥ 50 ml definition. Compared to the qualitative method, the approximate “XYZ/2” method had a sensitivity (0.77), specificity (0.76), accuracy (0.77) and positive predictive value (0.87) to detect mismatch using the ≥ 50 ml definition. Conclusions: The approximate “XYZ/2” method is sufficient for classifying the presence of MRI determined mismatch in acute stroke patients and therefore is a potential tool when using MRI determined mismatch as an inclusion criteria for clinical trials.


Author(s):  
Winnie A. Mar

Chapter 117 discusses common medication-induced changes of the musculoskeletal system. The effect of corticosteroids on the musculoskeletal system, including osteoporosis and osteonecrosis, is discussed. Corticosteroids decrease osteoblastic activity, stimulate bone resorption, and decrease intestinal absorption of calcium. Complications of bisphosphonate therapy such as atypical femoral fractures and osteonecrosis of the jaw are reviewed. Myopathies and tendon pathologies are briefly discussed, as well as bony changes potentially seen with long-term voriconazole treatment. For osteoporosis, DXA scan is the gold standard, whereas radiography is usually the first imaging modality performed in patients on voriconazole therapy who present with pain.


2021 ◽  
Author(s):  
Bindiya Gupta ◽  
Rashmi Shreya ◽  
Shalini Rajaram ◽  
Anshuja Singla ◽  
Sandhya Jain ◽  
...  

Abstract Purpose: Standardization of colposcopic evaluation is important as it is observer dependent.The aim of the study was to compare the strength of association of colposcopic findings by International Federation of Colposcopy and Cervical Pathology (IFCPC) nomenclature and Swede score. Methods: In the prospective study, 150 women aged 30 to 60 years with abnormal screening results underwent colposcopy, the findings were evaluated using both IFCPC and Swede score and biopsy was taken from abnormal areas. Performances by both the methods were calculated taking biopsy as gold standard. Results: Nineteen ≥ CIN2 lesions were detected. The sensitivity, specificity, positive predictive value and negative predictive value for detecting ≥ CIN2 lesion by IFCPC scoring was 63.6%, 96.0%, 78.7%, 91.9%. Using Swede score, sensitivity, specificity, positive predictive value and negative predictive value at cut off of 8 were 42.4, 95%, 96.6% and 81.8% while at cut-off of 5, these were 96%, 88.3%,76.7% and 93.6%. The agreement between IFCPC major lesion and Swede score ≥ 8 for ≥ CIN2 was 0.626 (p<0.01). Conclusion: Swede score is an easier and more objective method for colposcopic evaluation and a score >8 can be applied to the screen and treat programme.


2019 ◽  
Author(s):  
Christine Costa ◽  
André Barros ◽  
João Valença Rodrigues ◽  
Richard Staats ◽  
Mariana Alves ◽  
...  

AbstractBackground:The Hypoxia Altitude Simulation Test (HAST) is the Gold Standard to evaluate hypoxia in response to altitude and to decide on in-flight requirements for oxygen supplementation. Several equations are available to predict PaO2 in altitude (PaO2alt), but it remains unclear whether their predictive value is equivalent. We aimed to compare the results obtained by the available methods in a population of cystic fibrosis (CF) adults.Methods:Eighty-eight adults (58 healthy controls and 30 CF patients) performed a spirometry followed by an HAST. HAST results were compared with the predicted PaO2alt made by five equations: 1st: PaO2alt= 0,410 x PaO2ground + 1,7652; 2nd: PaO2alt= 0,519 x PaO2ground + 11,855 x FEV1 (L) − 1,760; 3rd: PaO2alt= 0,453 x PaO2ground + 0,386 x FEV1 (%) + 2,44; 4th: PaO2alt= 0,88 + 0,68 x PaO2ground; 5th: PaO2alt= PaO2ground − 26,6.Results:None of the controls required in-flight oxygen neither by HAST or by the five predictive equations. Eleven CF-patients had PaO2alt < 50 mmHg, accessed by HAST. The positive predictive value was 50% (1st), 87.5% (2nd and 3rd), 77.78% (4th) and 58.33% (5th). Areas under the curve were 78.95% (1st), 84.69% (2nd), 88.04% (3rd) and 78.95% (4th and 5th). FEV1 and PaO2ground were correlated with HAST results.Conclusions:The 3rd equation gave the best predictions in comparison with results obtained by HAST. However, because the individual differences found were substantial for all equations, we still recommend performing a HAST whenever possible to confidently access in-flight hypoxia and the need for oxygen.


Author(s):  
Danquale Vance Kynshikhar ◽  
Chaman Lal Kaushal ◽  
Ashwani Tomar ◽  
Neeti Aggarwal

Background: To study the diagnostic accuracy of ultrasound in the detection of pneumothorax in chest trauma patients with CT as the Gold Standard Methods: The present study was conducted from 31th July 2018 to 30th July 2019. A total of 36 patients were enrolled in the study. Results: By chest ultrasound, pneumothorax was detected in 15 of 24 patients. The sensitivity of chest ultrasound for the diagnosis of pneumothorax was 62.5%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 54.14% and accuracy was 75%. Conclusion: Chest ultrasound can play an important role in the emergency department aiding a physician for bedside rapid and accurate diagnosis of pneumothorax without interruption in the resuscitation process and without transferring the patient to the radiology section. Keywords: Ultrasound, CT, Pneumothorax


2016 ◽  
Vol 23 (09) ◽  
pp. 1045-1051
Author(s):  
Adnan Ahmed ◽  
Mushtaque Ali Memon ◽  
Muhammad Iqbal

Objectives: The objective of this study was to determine the diagnosticaccuracy of CT scan in detecting thyroid cartilage invasion by carcinoma of larynx keepinghistopathological findings as a gold standard. Study Design: Cross sectional and descriptivestudy. Setting: Department of Radiology of LUMHS, And Karachi Institute of Radiotherapy &Nuclear Medicine. Period: February 2013 to August 2015. Subjects and Methods: Overall 86patients were incorporated in this study. All these patients subsequently had their histopathology.The CT outcomes were then contrasted with histopathological results & measures of variablescalculated, were based on the results. Results: Fifty patients were men & 36 patients werewomen. The ages varied from 31 to 65yrs with mean age of 50yrs. The specificity & sensitivityof CT in diagnosing thyroid cartilage invasion was 84.5% and 93.3% respectively. Accuratenessof CT in diagnosing thyroid cartilage invasion was 86.05%. Conclusion: The study establishedthe specificity, sensitivity, negative as well as positive predictive value and accuracy of CTscan for the detection of thyroid cartilage invasion as 84.5%, 93.3%, 98.4%, 56% and 86.05%respectively. Very low negative predictive value was found in patients of age more than 50 years.


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