A New Evaluation Method for Lumbar Spinal Instability: Passive Lumbar Extension Test

Abstract Background and PurposeAlthough many studies have described clinical examination measures for the diagnosis of lumbar spinal instability, few of them have investigated the sensitivity and specificity of the measures that were used. The authors devised a passive lumbar extension (PLE) test for assessing lumbar spinal instability. The purpose of this study was to investigate the sensitivity, specificity, and positive likelihood ratio of this test. Subjects and Methods. The PLE test as well as the instability catch sign, painful catch sign, and apprehension sign tests were done for 122 subjects with lumbar degenerative diseases. The subjects were divided into 2 groups—instability positive and instability negative—on the basis of findings on flexion-extension films of the lumbar spine. The sensitivity, specificity, predictive values, and positive likelihood ratio of each test were investigated. Results. The sensitivity and specificity of the PLE test were 84.2% and 90.4%, respectively. These values were higher than those of other signs. The positive likelihood ratio of the PLE test was 8.84 (95% confidence interval=4.51–17.33). Discussion and Conclusion. The PLE test is an effective method for examining patients for lumbar spinal instability and can be performed easily in an outpatient clinic.

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Clinical utility of microRNA-451 as diagnostic biomarker for human cancers

Bioscience Reports ◽

10.1042/bsr20180653 ◽

2019 ◽

Vol 39 (1) ◽

Cited By ~ 4

Author(s):

Zhanzhan Li ◽

Yanyan Li ◽

Jun Fu ◽

Na Li ◽

Liangfang Shen

Keyword(s):

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Odds Ratio ◽

Random Effect ◽

Random Effect Model ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Diagnostic Ability ◽

Sensitivity Specificity

AbstractWe conducted comprehensive analyses to assess the diagnostic ability of miRNA-451 in cancers. A systematic online search was conducted in PubMed, Web of Science, China’s national knowledge infrastructure, and VIP databases from inception to July 31, 2017. The bivariate random effect model was used for calculating sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under cure (AUC). The whole pooled sensitivity and specificity were 0.85 (0.77–0.90) and 0.85 (0.78–0.90) with their 95% confidence interval (95%CI), respectively. The pooled AUC was 0.91 (95%CI: 0.89–0.94). Positive likelihood ratio was 5.57 (95%CI: 3.74–8.31), negative likelihood ratio was 0.18 (95%CI: 0.11–0.28), and diagnostic odds ratio was 31.33 (95%CI: 15.19–64.61). Among Asian population, the sensitivity and specificity were 0.85 (95%CI: 0.77–0.91) and 0.86 (95%CI: 0.78–0.91), respectively. The positive likelihood ratio and negative likelihood ratio were 5.87 (95%CI: 3.78–9.12) and 0.17 (95%CI: 0.11–0.28). The diagnostic odds ratio and AUC were 34.31 (15.51–75.91) and 0.92 (0.89–0.94). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and AUC for digestive system cancer were 0.83, 0.88, 6.87, 0.20, 35.13, and 0.92, respectively. The other cancers were 0.87, 0.81, 4.55, 0.16, 28.51, and 0.90, respectively. For sample source, the results still remain consistent. Our results indicated miRNA-451 has a moderate diagnostic ability for cancers, and could be a potential early screening biomarker, and considered as an adjuvant diagnostic index when being combined with other clinical examinations.

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Interpretations of the dial test should be reconsidered. A diagnostic accuracy study reporting sensitivity, specificity, predictive values and likelihood ratios

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2018-000197 ◽

2018 ◽

Vol 3 (4) ◽

pp. 198-204

Author(s):

Richard Norris ◽

Christian Kopkow ◽

Michael James McNicholas

Keyword(s):

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Predictive Value ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Knee Ligament ◽

Predictive Values ◽

Medial Knee ◽

Sensitivity Specificity ◽

Dial Test

ObjectivesTo determine the accuracy of the dial test, used alone and in combination with additional clinical tests, in the diagnosis of an isolated posterolateral corner (PLC) injury, combined PLC-posterior cruciate ligament (PCL) injury or medial knee injury.MethodsA retrospective analysis of consecutive patients who underwent arthroscopic and/or open knee ligament reconstruction surgery was conducted. The dial test was performed in an outpatient’s clinic as part of a routine knee examination. Examination under anaesthetic and intraoperative findings were used as the reference standard test to determine the diagnostic accuracy of the dial test used alone and in combination with other PCL and medial knee tests. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−) were calculated with corresponding 95% CI.ResultsData from 87 patients were available and included in the data analysis. For an isolated PLC injury, the dial test sensitivity and specificity were 0.20 (95% CI 0.08 to 0.39) and 1.00 (95% CI 0.92 to 1.00). The PPV and NPV were 1.00 (95% CI 0.52 to 1.00) and 0.70 (95% CI 0.59 to 0.80). LR+ and LR− of the dial test detecting isolated PLC injury were infinity (95% CI calculation not possible, infinity) and 0.80 (95% CI 0.41 to 1.57). The diagnostic accuracy of the dial test, when used alone and in combination with other PCL and medial knee tests, was also calculated for combined PLC-PCL and medial knee injuries.ConclusionA negative dial test at 30° of knee flexion can rule out a PLC injury, while a test that is positive at 30° and negative at 90° indicates a PLC injury, without concomitant injury to the PCL or medial knee ligaments. A positive test at both 30° and 90° can indicate isolated PLC, combined PLC-PCL or medial ligament injuries, and other knee examination findings are required to differentially diagnose these injury patterns.Level of evidenceII.

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Diagnostic Laboratory Tests for COVID-19 in US: Methodology and Performance

10.21203/rs.3.rs-43374/v1 ◽

2020 ◽

Author(s):

Mrigendra M. Bastola ◽

Craig Locatis ◽

Paul Fontelo

Keyword(s):

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Small Sample ◽

Published Data ◽

Test Accuracy ◽

Rt Pcr ◽

Likelihood Ratios ◽

Predictive Values

Abstract Background: COVID-19 is a global pandemic caused by a new coronavirus strain. Innovative tests have been developed to diagnose and characterize the spread of COVID-19. Only a few studies have reported the diagnostic value of currently available tests. The diagnostic performance of the tests is a major concern after the recent resurgence in COVID-19. Methods: Published papers and FDA data on the currently available tests were used for analysis. Likelihood ratios, and predictive values of tests were computed. Only FDA approved tests were included. RT-PCR performance among different specimen types were also explored.Main results: All the published reports on the COVID-19 tests reported RT-PCR as the validation tool for their results. Not all available COVID-19 tests reported their sensitivity and specificity. Among the publications which reported, the positive likelihood ratio ranged between 0.15 to 0.88 and tests had high negative likelihood ratio (0.99). Conclusion: Although most recent publications showed high positive and negative likelihood ratios and high predictive values, the publications on test accuracy and validity have limited scope primarily due to their small sample size and insufficiencies in methodology and published data. Although most lab tests reported high sensitivity and specificity, false omission and false discovery rates were found notable in several COVID-19 lab tests. These results suggest need for caution on test results’ interpretation. Practitioners also need to integrate evidence that is evolving rapidly.

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The use of 4.5% hypertonic saline challenge test in diagnosing asthma in children with chronic recurrent cough

Paediatrica Indonesiana ◽

10.14238/pi45.3.2005.93-8 ◽

2016 ◽

Vol 45 (3) ◽

pp. 93

Author(s):

Bambang Supriyatno ◽

Dina Medina ◽

Alan R Tumbelaka ◽

Nastiti N Rahajoe

Keyword(s):

Hypertonic Saline ◽

Likelihood Ratio ◽

Challenge Test ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Provocation Test ◽

Likelihood Ratios ◽

Predictive Values ◽

Sensitivity Specificity ◽

Histamine Challenge

Background The 4.5% hypertonic saline (HS) challenge test hasseveral benefits compared to histamine challenge test as gold stan-dard. Saline is an inexpensive non-pharmacological substancewhich is relatively safe. Its mechanism in inducing bronchospasmresembles that of asthma. Moreover, it can easily be made in amodest medical laboratory.Objective To determine the ability of 4.5% HS challenge test com-pared to histamine challenge test in diagnosing asthma in childrenwith chronic recurrent cough (CRC).Methods This study was a diagnostic test on children with CRCaged 6 to 14 years, conducted in outpatient clinic of Department ofChild Health, Cipto Mangunkusumo Hospital, Jakarta. All subjectsunderwent lung function tests. Subjects whose FEV 1 was <80% werediagnosed as asthmatic and underwent the 4.5% HS challenge testonly. Those whose FEV 1 was 80% underwent the histamine chal-lenge test followed by the 4.5% HS challenge test one or two weekslater. Test results were expressed as positive or negative. Based onthe results, we calculated the sensitivity, specificity, predictive val-ues, and likelihood ratios of the 4.5% HS challenge test.Results Forty-five subjects, consisting of 22 boys and 23 girls,were enrolled. The average age of subjects was 9 years old. Atopichistory in the family or in subjects themselves was found in 80% ofsubjects. Eight subjects had FEV 1 of <80%. Forty-four subjectswere diagnosed with asthma based on a baseline FEV 1 of <80%or a positive histamine provocation test. Thirty-seven subjects hada positive 4.5% HS challenge test; all had asthma. Sensitivity andspecificity of the 4.5% HS challenge test were 84.1% and 100.0%,respectively; the positive and negative predictive values were100.0% and 12.5%, respectively. The positive likelihood ratio wasinfinite and negative likelihood ratio was 0.16.Conclusion The 4.5% hypertonic saline challenge test can be usedas an alternative bronchial provocation test in diagnosing asthma inchildren with CRC. Further study with larger sample size is neededfor widespread usage.

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53. A new evaluation method for lumbar spinal instability: passive lumbar extension test

The Spine Journal ◽

10.1016/j.spinee.2004.05.054 ◽

2004 ◽

Vol 4 (5) ◽

pp. S29

Author(s):

Yuichi Kasai ◽

Koichiro Morishita ◽

Atsumasa Uchida

Keyword(s):

Evaluation Method ◽

Spinal Instability ◽

Lumbar Extension ◽

Lumbar Spinal

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Prediction of Difficult Tracheal Videolaryngoscopic Intubation Using El-Ganzouri Risk Index

Acta Chirurgica Latviensis ◽

10.1515/chilat-2017-0012 ◽

2017 ◽

Vol 17 (1) ◽

pp. 18-22

Author(s):

Antons Zakalkins ◽

Sigita Kazune

Keyword(s):

Sensitivity And Specificity ◽

Predictive Value ◽

Evaluation Method ◽

Characteristic Curve ◽

Risk Index ◽

Predictive Values ◽

Specificity And Sensitivity ◽

Laryngeal Exposure ◽

Sensitivity Specificity ◽

Induction Of Anaesthesia

Summary Introduction. Unanticipated difficult intubation still exists as a significant problem. El-Ganzouri risk index is a bedside difficult airway evaluation method, which can help determine risk of difficult airways. However, evidence of using of El-Ganzouri risk index in difficult laryngeal visualisation using videolaryngoscopes is limited. Aim of the Study. Determine the specificity and sensitivity of El-Ganzouri multivariate risk index to predict difficult laryngeal exposure using Storz C-MAC videolaryngoscope equipped with D type blade. Material and methods. We conducted a study of 29 patients, which were examined using El-Ganzouri risk index before induction of anaesthesia. After induction of anaesthesia videolaryngoscopy was performed using Storz C-MAC videolaryngoscope equipped with D-blade and laryngeal visualisation was graded using Cormack-Lehane scale. After laryngeal visualisation grading endotracheal tube insertion was performed and numbers of attempts as well as complications during intubation were recorded. Sensitivity, specificity, positive and negative predictive values were calculated, receiver operating characteristic curve and area under curve was obtained. Results. Sensitivity and specificity were 54.2% and 80.0% at El-Ganzouri risk index cut-off value of 2 points. Calculated positive predictive value was 26.7% and negative predictive value was 92.9%. Calculated AUC was 78.3%. Conclusions. El-Ganzouri risk index shows moderate sensitivity and specificity when used with Storz C-MAC videolaryngoscope. It can be used to predict difficult laryngeal visualization during videolaryngoscopic intubation.

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Diagnostic value of urine Gram staining for urinary tract infection in children

Paediatrica Indonesiana ◽

10.14238/pi49.4.2009.205-8 ◽

2009 ◽

Vol 49 (4) ◽

pp. 205

Author(s):

I Nyoman Sartika ◽

Ketut Suarta ◽

Pungky Ardhani

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Positive Result ◽

Likelihood Ratio ◽

Microscopic Examination ◽

Urine Culture ◽

Positive Likelihood Ratio ◽

Predictive Values ◽

Sensitivity Specificity

Background Urine culture is the standard procedure for diagnosisof urinary tract infection (UTI). To reduce the cost and timespent in examining cultures, several rapid methods have beendeveloped including microscopic examination, chemical tests,and automated systems.Objective To determine the value of microscopic examination of a Gram stained uncentrifuged drop of urine for diagnosis of UTI.Methods We carried out a diagnostic test in Sanglah Hospital,Denpasar, from January 2007 to December 2007. Midstream urine specimens were Gram stained and then examined using a high power oil immersion lens. Twenty fields of view were examined and finding of two or more microorganisms was taken as positive result. Urine was also cultured and a yield of more than 105 CFU/ml was taken as positive result. The sensitivity, specificity, and predictive values of Gram stained urine were determined using urine culture as gold standard.Results From 43 subjects in our study, 12 subjects (28%) hadpositive urine culture. The prevalence was higher in males (58%)than females. UTI was most commonly caused by Klebsiellapneumoniae (33%). The sensitivity, specificity, positive predictivevalue, and negative predictive valuey, of the urine Gram stainwere 67% (95%CI 40 to 93), 9.7% (95%CI 91 to 100), 89%,88%, respectively. The accuracy, positive likelihood ratio, negative likelihood ratio, and post-test probability of the urine Gram stain were 88, 21, 0.3, and 89%, respectively.Conclusion Microscopic examination of Gram stained uncentrifuged drop of urine is specific and accurate, but not sensitive for the diagnosis of UTI.

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The Potential Diagnostic Accuracy of Circulating MicroRNAs for Leukemia: A Meta-Analysis

Technology in Cancer Research & Treatment ◽

10.1177/15330338211011958 ◽

2021 ◽

Vol 20 ◽

pp. 153303382110119

Author(s):

Wen-Ting Zhang ◽

Guo-Xun Zhang ◽

Shuai-Shuai Gao

Keyword(s):

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Subgroup Analysis ◽

Meta Analysis ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Circulating Micrornas ◽

Sensitivity Specificity

Background: Leukemia is a common malignant disease in the human blood system. Many researchers have proposed circulating microRNAs as biomarkers for the diagnosis of leukemia. We conducted a meta-analysis to evaluate the diagnostic accuracy of circulating miRNAs in the diagnosis of leukemia. Methods: A comprehensive literature search (updated to October 13, 2020) in PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang database and China National Knowledge Infrastructure (CNKI) was performed to identify eligible studies. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) for diagnosing leukemia were pooled for both overall and subgroup analysis. The meta-regression and subgroup analysis were performed to explore heterogeneity and Deeks’ funnel plot was used to assess publication bias. Results: 49 studies from 22 publications with a total of 3,489 leukemia patients and 2,756 healthy controls were included in this meta-analysis. The overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the curve were 0.83, 0.92, 10.8, 0.18, 59 and 0.94, respectively. Subgroup analysis shows that the microRNA clusters of plasma type could carry out a better diagnostic accuracy of leukemia patients. In addition, publication bias was not found. Conclusions: Circulating microRNAs can be used as a promising noninvasive biomarker in the early diagnosis of leukemia.

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Optimal Range of Fecal Calprotectin for Predicting Mucosal Healing in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Visceral Medicine ◽

10.1159/000514196 ◽

2021 ◽

pp. 1-11

Author(s):

Bing-Jie Xiang ◽

Min Jiang ◽

Ming-Jun Sun ◽

Cong Dai

Keyword(s):

Inflammatory Bowel Disease ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Bowel Disease ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Inflammatory Bowel

Objective: Fecal calprotectin (FC) is a promising marker for assessment of inflammatory bowel disease (IBD) activity. However, the utility of FC for predicting mucosal healing (MH) of IBD patients has yet to be clearly demonstrated. The objective of our study was to perform a meta-analysis evaluating the diagnostic accuracy of FC in predicting MH of IBD patients. Methods: We systematically searched the databases for studies from inception to April 2020 that evaluated MH in IBD. The methodological quality of each study was assessed according to the Quality Assessment of Diagnostic Accuracy Studies checklist. The extracted data were pooled using a summary receiver operating characteristic curve model. Random-effects model was used to summarize the diagnostic odds ratio, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Results: Sixteen studies comprising 1,682 ulcerative colitis (UC) patients and 4 studies comprising 221 Crohn’s disease (CD) patients were included. The best performance of FC for predicting MH in UC was at cut-off range of 60–75 μg/g with area under the curve (AUC) of 0.88 and pooled sensitivity and specificity of 0.87 and 0.79, respectively. The pooled sensitivity and specificity values of cutoff range 180–250 μg/g for predicting MH in CD were 0.67 and 0.76, respectively. The AUC of 0.79 also revealed improved discrimination for identifying MH in CD with FC concentration. Conclusion: Our meta-analysis has found that FC is a simple, reliable noninvasive marker for predicting MH in IBD patients. FC cutoff range 60–75 μg/g appears to have the best overall accuracy in UC patients.

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Diagnostic performances of manual and automated reticulocyte parameters in anaemic cats

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x17699067 ◽

2017 ◽

Vol 20 (2) ◽

pp. 122-127 ◽

Cited By ~ 2

Author(s):

Saverio Paltrinieri ◽

Marco Fossati ◽

Valentina Menaballi

Keyword(s):

Receiver Operating Characteristic ◽

Sensitivity And Specificity ◽

Operating Characteristic ◽

Positive Likelihood Ratio ◽

Roc Curves ◽

Blood Samples ◽

Production Index ◽

Instrumental Measurement ◽

Sensitivity Specificity ◽

Reticulocyte Production

Objectives The objective of this study was to evaluate the diagnostic performances of manual and instrumental measurement of reticulocyte percentage (Ret%), reticulocyte number (Ret#) and reticulocyte production index (RPI) to differentiate regenerative anaemia (RA) from non-regenerative anaemia (NRA) in cats. Methods Data from 106 blood samples from anaemic cats with manual counts (n = 74; 68 NRA, six RA) or instrumental counts of reticulocytes (n = 32; 25 NRA, seven RA) collected between 1995 and 2013 were retrospectively analysed. Sensitivity, specificity and positive likelihood ratio (LR+) were calculated using either cut-offs reported in the literature or cut-offs determined from receiver operating characteristic (ROC) curves. Results All the reticulocyte parameters were significantly higher in cats with RA than in cats with NRA. All the ROC curves were significantly different ( P <0.001) from the line of no discrimination, without significant differences between the three parameters. Using the cut-offs published in literature, the Ret% (cut-off: 0.5%) was sensitive (100%) but not specific (<75%), the RPI (cut-off: 1.0) was specific (>92%) but not sensitive (<15%), and the Ret# (cut-off: 50 × 10³/µl) had a sensitivity and specificity >80% and the highest LR+ (manual count: 14; instrumental count: 6). For all the parameters, sensitivity and specificity approached 100% using the cut-offs determined by the ROC curves. These cut-offs were higher than those reported in the literature for Ret% (manual: 1.70%; instrumental: 3.06%), lower for RPI (manual: 0.39; instrumental: 0.59) and variably different, depending on the method (manual: 41 × 10³/µl; instrumental: 57 × 10³/µl), for Ret#. Using these cut-offs, the RPI had the highest LR+ (manual: 22.7; instrumental: 12.5). Conclusions and relevance This study indicated that all the reticulocyte parameters may confirm regeneration when the pretest probability is high, while when this probability is moderate, RA should be identified using the RPI providing that cut-offs <1.0 are used.

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