Prevalence and Prognosis of Fever Symptoms, Hypo-, and Hyperthermia in Unselected Emergency Patients

Assessments of history and body temperature are cornerstones of the diagnostic workup in all patients presenting to emergency departments (ED). Yet, the objective measurement of temperature and the subjective perception of fever can differ. This is a secondary exploratory analysis of a consecutive all-comer study, performed at an adult ED in Switzerland. Trained medical students interviewed all patients if fever was present. Altered temperature (>38.0 °C/<36.0 °C) measured at triage using an ear thermometer was used as the reference standard for diagnostic performance. In case of a disagreement between fever symptoms and altered temperature, discordance was noted. Outcome measures for case severity (acute morbidity, hospitalization, intensive care, and in-hospital mortality) were extracted from the electronic health records. Odds ratios (OR) for discordance between signs and symptoms and outcomes were calculated. Among 2183 patients, 325 patients reported fever symptoms. The sensitivity of fever symptoms as a test for altered temperature was 36.3%. Specificity was 91.5%. The negative predictive value was 84.1%, positive likelihood ratio was 4.2 and negative likelihood ratio was 0.7. The adjusted OR for discordance between fever symptoms and altered temperature was 1.71 (95% CI: 1.2–2.44) for acute morbidity, 1.56 (95% CI: 1.13–2.15) for hospitalization, and 1.12 (95% CI: 0.64–1.59) for intensive care. Unadjusted OR for mortality was 1.5 (95% CI: 0.69–3.25). Fever symptoms and altered temperature broadly overlap, but presentations can be stratified according to concordance between signs and symptoms. In case of discordance, the odds for acute morbidity and hospitalization are increased. Discordance may therefore be further investigated as a red flag for a serious outcome.

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Lung ultrasound in the diagnosis of pneumonia in children: proposal for a new diagnostic algorithm

PeerJ ◽

10.7717/peerj.1374 ◽

2015 ◽

Vol 3 ◽

pp. e1374 ◽

Cited By ~ 28

Author(s):

Giulio Iorio ◽

Maria Capasso ◽

Giuseppe De Luca ◽

Salvatore Prisco ◽

Carlo Mancusi ◽

...

Keyword(s):

Likelihood Ratio ◽

Medical Records ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Algorithm ◽

Signs And Symptoms ◽

Community Acquired Pneumonia ◽

Radiographic Findings ◽

Alternative Test ◽

Respiratory Signs And Symptoms

Background.Despite guideline recommendations, chest radiography (CR) for the diagnosis of community-acquired pneumonia (CAP) in children is commonly used also in mild and/or uncomplicated cases. The aim of this study is to assess the reliability of lung ultrasonography (LUS) as an alternative test in these cases and suggest a new diagnostic algorithm.Methods.We reviewed the medical records of all patients admitted to the pediatric ward from February 1, 2013 to December 31, 2014 with respiratory signs and symptoms. We selected only cases with mild/uncomplicated clinical course and in which CR and LUS were performed within 24 h of each other. The LUS was not part of the required exams recorded in medical records but performed independently. The discharge diagnosis, made only on the basis of history and physical examination, laboratory and instrumental tests, including CR (without LUS), was used as a reference test to compare CR and LUS findings.Results.Of 52 selected medical records CAP diagnosis was confirmed in 29 (55.7%). CR was positive in 25 cases, whereas LUS detected pneumonia in 28 cases. Four patients with negative CR were positive in ultrasound findings. Instead, one patient with negative LUS was positive in radiographic findings. The LUS sensitivity was 96.5% (95% CI [82.2%–99.9%]), specificity of 95.6% (95% CI [78.0%–99.9%]), positive likelihood ratio of 22.2 (95% CI [3.2–151.2]), and negative likelihood ratio of 0.04 (95% CI [0.01–0.25]) for diagnosing pneumonia.Conclusion.LUS can be considered as a valid alternative diagnostic tool of CAP in children and its use must be promoted as a first approach in accordance with our new diagnostic algorithm.

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Comparison of contrast-enhanced ultrasound with MRI in the diagnosis of complex cystic renal masses: a meta-analysis

Acta Radiologica ◽

10.1177/0284185118755575 ◽

2018 ◽

Vol 59 (10) ◽

pp. 1254-1263 ◽

Cited By ~ 8

Author(s):

Linli Zhou ◽

Lemin Tang ◽

Tao Yang ◽

Wei Chen

Keyword(s):

Likelihood Ratio ◽

Diagnostic Performance ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Contrast Enhanced Ultrasound ◽

Diagnostic Efficacy ◽

Renal Masses ◽

Contrast Enhanced ◽

Sensitivity Specificity

Background The differential diagnosis of cystic renal masses still faces great challenges. There has been no systematically assessment to compare the value of contrast-enhanced ultrasound (CEUS) with magnetic resonance imaging (MRI) in the diagnosis of cystic renal masses. Purpose To perform a meta-analysis to compare the diagnostic efficacy of CEUS with that of MRI for cystic renal masses. Material and Methods A systematic search was performed for literature evaluating the diagnostic performance of CEUS or MRI in cystic renal masses. Quality assessment of diagnostic studies 2 (QUADAS-2) was used to evaluate the quality of each study included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and the areas under the summary receiver operating characteristic (AUCs-SROC) curve for CEUS and MRI were calculated, respectively. Results Seventeen studies with 1142 lesions were included. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for CEUS /MRI were 0.95/0.92, 0.84/0.91, 5.62/6.74, and 0.09/0.13, respectively. The AUCs-SROC curves for the two methods were 95.66% and 94.65%. The subgroup analysis indicated that the scanning slice thickness may influence the diagnostic efficacy of MRI. Conclusion Both CEUS and MRI have good diagnostic performance for cystic renal masses and can provide the reference for clinicians. CEUS is more sensitive but less specific than MRI.

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Diagnostic performance of circulating cell-free DNA for hepatocellular carcinoma: a systematic review and meta-analysis

Biomarkers in Medicine ◽

10.2217/bmm-2020-0334 ◽

2021 ◽

Vol 15 (3) ◽

pp. 219-239

Author(s):

Jinmei Zhang ◽

Yuan Yuan ◽

Shuxia Gao ◽

Xue Zhao ◽

Hong Li

Keyword(s):

Likelihood Ratio ◽

Odds Ratio ◽

Diagnostic Performance ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Receiver Operating Characteristics ◽

Operating Characteristics ◽

Free Dna ◽

Sensitivity Specificity

Background: We aimed to assess the diagnostic performance of circulating cell-free DNA (cfDNA) in hepatocellular carcinoma (HCC). Materials & methods: After a systematic literature search bivariate linear mixed models were used to integrate sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio. The area under receiver operating characteristics curves of the included studies was used to estimate the diagnostic value. Results: Thirty-eight articles enrolled in quantitative synthesis. In overall analysis the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under receiver operating characteristics curves for cfDNA in distinguishing HCC patients from healthy controls were 0.54, 0.90, 5.23, 0.51, 10.27 and 0.82, respectively. Conclusion: This study suggests that cfDNA has a promising diagnostic accuracy in detection of HCC.

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Diagnostic performance of PET in thyroid cancer with elevated anti-Tg Ab

Endocrine Related Cancer ◽

10.1530/erc-17-0341 ◽

2018 ◽

Vol 25 (6) ◽

pp. 643-652 ◽

Cited By ~ 4

Author(s):

Seong-Jang Kim ◽

Sang-Woo Lee ◽

Kyoungjune Pak ◽

Sung-Ryul Shim

Keyword(s):

Thyroid Cancer ◽

Likelihood Ratio ◽

Fdg Pet ◽

Diagnostic Performance ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Whole Body ◽

Cochrane Library ◽

Pet Ct ◽

Fdg Pet Ct

We aimed to explore the role of the diagnostic accuracy of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for the detection of recurrent and/or metastatic diseases in differentiated thyroid cancer (DTC) patients with progressively and/or persistently elevated TgAb levels and negative radioactive iodine whole-body scan (RI-WBS) through a systematic review and meta-analysis. The MEDLINE, EMBASE and Cochrane Library database, from the earliest available date of indexing through June 30, 2017, were searched for studies evaluating the diagnostic performance of F-18 FDG PET/CT for the detection of recurrent and/or metastatic diseases in DTC patients with progressively and/or persistently elevated TgAb levels and negative RI-WBS. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR−). Across 9 studies (515 patients), the pooled sensitivity for F-18 FDG PET/CT was 0.84 (95% CI; 0.77–0.89) a pooled specificity of 0.78 (95% CI; 0.67–0.86). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 3.8 (95% CI; 2.5–5.7) and negative likelihood ratio (LR−) of 0.21 (95% CI; 0.14–0.30). The pooled diagnostic odds ratio (DOR) was 18 (95% CI; 10–34). The area (AUC) under the hierarchical summary receiver-operating characteristic (HCROC) curve was 0.88 (95% CI: 0.85–0.90). F-18 FDG PET or PET/CT demonstrated moderate sensitivity and specificity for the detection of recurrent and/or metastatic diseases in DTC patients with progressively and/or persistently elevated TgAb levels and negative RI-WBS.

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The Diagnostic Performance of lncRNAs from Blood Specimens in Patients with Hepatocellular Carcinoma: A Meta-Analysis

Laboratory Medicine ◽

10.1093/labmed/lmaa050 ◽

2020 ◽

Vol 52 (1) ◽

pp. 64-73

Author(s):

Jing-Yi Huang ◽

Si-Yu Wang ◽

Yong Lin ◽

Huo-Chun Yi ◽

Jian-Jun Niu

Keyword(s):

Hepatocellular Carcinoma ◽

Likelihood Ratio ◽

Diagnostic Performance ◽

Meta Analysis ◽

Exclusion Process ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Relevant Information ◽

Diagnostic Odds Ratio ◽

Linear Regression Method

Abstract Objective Long noncoding RNAs (lncRNAs) are widely involved in the carcinogenesis and development of cancers. We conducted a meta-analysis to evaluate the diagnostic performance of lncRNAs in hepatocellular carcinoma (HCC). Methods After the inclusion and exclusion process, relevant information was extracted. Heterogeneity between studies was evaluated, and data synthesis was conducted by employing a bivariate random-effects model. Results In total, 20 eligible studies were enrolled. The pooled sensitivity and specificity were 0.86 (95% confidence interval [CI], 0.80–0.90) and 0.88 (95% CI, 0.82–0.92), respectively. The pooled positive likelihood ratio, pooled negative likelihood ratio, and pooled diagnostic odds ratio were 7.1 (95% CI, 4.9–10.2), 0.16 (95% CI, 0.11–0.23), and 44 (95% CI, 25–79), respectively. The results of the linear regression method and visual inspection of the Deeks funnel plot did not indicate significant publication bias. Conclusion Our meta-analysis suggested that lncRNAs have high diagnostic performance for HCC and have the potential for clinical application.

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Diagnostic performance of ID Screen® MVV-CAEV Indirect Screening ELISA in identifying small ruminant lentiviruses-infected goats

Polish Journal of Veterinary Sciences ◽

10.2478/pjvs-2014-0072 ◽

2014 ◽

Vol 17 (3) ◽

pp. 501-506 ◽

Cited By ~ 13

Author(s):

D. Nowicka ◽

M. Czopowicz ◽

M. Mickiewicz ◽

O. Szaluś-Jordanow ◽

L. Witkowski ◽

...

Keyword(s):

Likelihood Ratio ◽

Serum Sample ◽

Diagnostic Performance ◽

Small Ruminant ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Sample Collection ◽

Serum Samples ◽

Wide Range ◽

Small Ruminant Lentiviruses

AbstractDiagnostic performance of ID Screen®MVV-CAEV Indirect Screening ELISA in identifying goats infected with small ruminant lentiviruses (SRLV) was evaluated. In total 299 serum samples from the collection of the Laboratory of Veterinary Epidemiology and Economics - 109 truly positive and 190 truly negative - were used. To be enrolled in the study a serum sample had to come from at least 2 year-old goat which had reacted identically in two serological surveys preceding sample collection and was kept in a herd of stable serological status confirmed at least twice during preceding 5 years. Moreover, in seropositive herds at least 20% of goats had to be serologically positive at the moment when the serum sample was collected for the study. The test proved to have high accuracy. Area under curve was 98.8% (95% CI: 97.5%, 100%). Diagnostic performance of the test was almost identical (Youlden’s index of 90%, sensitivity >90% and specificity >95%) within a fairly wide range of cut-off values - between 20% and 60%. At manufacturer’s cut-off of 50% sensitivity and specificity were 91.7% (95% CI: 85.0%, 95.6%) and 98.9% (95% CI: 96.2%, 99.7%), respectively. For this cut-off positive likelihood ratio was 87 (95% CI: 22, 346) and negative likelihood ratio was 0.08 (95% CI: 0.04, 0.16). In conclusion, the results of this study indicate that ID Screen®MVV-CAEV Indirect Screening ELISA is a highly accurate diagnostic test for SRLV infection.

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Reliability of the Edinburgh Claudication Questionnaire for Identifying Symptomatic PAD in General Practice

Angiology ◽

10.1177/0003319720984882 ◽

2021 ◽

pp. 000331972098488

Author(s):

Luke Boylan ◽

Craig Nesbitt ◽

Lesley Wilson ◽

John Allen ◽

Andrew Sims ◽

...

Keyword(s):

General Practice ◽

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Methods ◽

Test Accuracy ◽

Reference Standard ◽

Ultrasound Scanning ◽

Vascular Ultrasound ◽

North East

The Edinburgh Claudication Questionnaire (ECQ) was developed to help identify peripheral arterial disease (PAD) in the general population but has not been validated against diagnostic arterial imaging methods such as Duplex Vascular Ultrasound Scanning (DUS). In the present study, we assessed the accuracy of the ECQ for diagnosis using DUS. As part of a National Institute of Health Research funded project looking at novel diagnostic methods, 250 patients were studied from 15 general practices across North East England from May 2015 and November 2016. Practices identified those with a PAD diagnosis from their registers as well as age- and sex-matched controls. All the ECQs were recorded by a vascular specialist nurse. Duplex vascular ultrasound scanning was used as a reference standard for the diagnosis of occlusive PAD. The ECQ had a sensitivity of 52.5% (95% CI: 42.3%-62.5%), specificity of 87.1% (95% CI: 80.6%-92.0%), positive likelihood ratio of 4.06 (95% CI: 2.57-6.42), and negative likelihood ratio of 0.55 (95% CI: 0.44-0.68) compared with reference standard DUS. The ECQ has relatively poor overall diagnostic test accuracy in isolation. It may be helpful in ruling out PAD or as a supplementary test to improve diagnosis of symptomatic disease in General Practice.

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Diagnostic Performance of Three-Phase Bone Scintigraphy and Digital Infrared Thermography Imaging for Chronic Post-Traumatic Complex Regional Pain Syndrome

Diagnostics ◽

10.3390/diagnostics11081459 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1459

Author(s):

Miju Cheon ◽

Hyo Jung Kang ◽

Kyung Hee Do ◽

Hee Seung Yang ◽

Eul Joo Han ◽

...

Keyword(s):

Diagnostic Criteria ◽

Infrared Thermography ◽

Bone Scintigraphy ◽

Likelihood Ratio ◽

Diagnostic Performance ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Uptake Pattern ◽

Three Phase ◽

Post Traumatic

This study aimed to evaluate the diagnostic performance of three-phase bone scintigraphy (TPBS) and digital infrared thermography imaging (DITI) in the chronic post-traumatic CRPS and propose new imaging diagnostic criteria that combine the two tests. We retrospectively enrolled 44 patients with suspected symptoms of CRPS from various injuries during obligatory military service. We analyzed the following findings: (1) uptake pattern on TPBS, (2) uptake ratios of affected and unaffected sides in each phase of TPBS, (3) difference in body skin temperature on DITI. New criteria combining the above findings were also evaluated. Eighteen patients were finally defined as CRPS according to the Budapest criteria. Uptake pattern and uptake ratio in blood pool phase on the TPBS were significantly different between CRPS and non-CRPS groups (both p < 0.05). The DITI could not discriminate significantly between the groups (p = 0.334). The diagnostic criteria considering both the pattern analysis and quantitative analysis in TPBS exhibited the highest positive likelihood ratio. On the other hand, the diagnostic criteria combining DITI and TPBS showed the lowest negative likelihood ratio value. TPBS can be useful in diagnosing chronic post-traumatic CRPS. Moreover, we can suggest that different diagnostic criteria be applied depending on the purpose.

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miRNA-21 may serve as a promising noninvasive marker of glioma with a high diagnostic performance: a pooled analysis of 997 patients

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835920987650 ◽

2021 ◽

Vol 13 ◽

pp. 175883592098765

Author(s):

Xinli Zhao ◽

Zhihong Xiao ◽

Bin Li ◽

Hongwei Li ◽

Bo Yang ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Diagnostic Performance ◽

Meta Analysis ◽

Prognostic Significance ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Therapeutic Effects ◽

Study Region ◽

Meta Regression

Background: Although various serum and tissue biomarkers have been investigated for glioma diagnosis, no gold standard has been identified. miRNA-21 was demonstrated to be a promising biomarker for the diagnosis of various brain tumors, whereas there remains uncertainty concerning whether miRNA-21 could be used as a good clinical diagnostic biomarker for glioma. The current meta-analysis aimed to evaluate the diagnostic accuracy of miRNA-21 as a potent biomarker in adults with suspected glioma. Methods: The Pubmed and Embase databases were searched systematically from inception to January 2020 to identify relevant research reports. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated. Summary receiver operating characteristic (SROC) curves were used to evaluate the overall diagnostic performance. Meta-regression and subgroup analyses were conducted to determine the source of heterogeneity and test the robustness of the results. Results: From 5394 citations with 997 subjects that met the inclusion criteria, 11 studies were selected. Summary estimates of the diagnostic performance of miRNA-21 were as follows: sensitivity, 0.83 [95% confidence interval (CI): 0.73–0.89]; specificity, 0.92 (95% CI: 0.85–0.96); PLR, 10.20 (95% CI: 5.10–20.30); NLR, 0.19 (95% CI: 0.12–0.31); and DOR, 54 (95% CI: 19–155). The area under the SROC curve was 0.94 (95% CI: 0.92–0.96). Deeks’s funnel plot revealed no evidence of publication bias ( p = 0.59). Meta-regression analysis suggested that study publication year could attribute to the heterogeneity. Subgroup analysis found miRNA-21 had a constant high diagnostic accuracy across different ethnicity, glioma grade, sample source, and study region. Conclusion: This meta-analysis demonstrated that miRNA-21 has high diagnostic performance and could serve as a promising noninvasive diagnostic marker for glioma. Further large prospective studies are needed to validate its diagnostic value and its prognostic significance and therapeutic effects.

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Diagnostic Role of Four-Dimensional Computed Tomography for Preoperative Parathyroid Localization in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics11040664 ◽

2021 ◽

Vol 11 (4) ◽

pp. 664

Author(s):

Lixin Sun ◽

Jian Yao ◽

Pan Hao ◽

Yuanyuan Yang ◽

Zhimou Liu ◽

...

Keyword(s):

Computed Tomography ◽

Primary Hyperparathyroidism ◽

Likelihood Ratio ◽

Diagnostic Performance ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

4D Ct ◽

Patient Level ◽

Lesion Level ◽

Sensitivity Specificity

We sought to systematically evaluate diagnostic performance of four-dimensional computed tomography (4D-CT) in the localization of hyperfunctioning parathyroid glands (HPGs) in patients with primary hyperparathyroidism (pHPT). We calculated the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratios (DOR) of 4D-CT on a per-lesion level, as well as pooled sensitivity and positive predictive value (PPV) on a per-patient level with 95% confidence intervals (CIs). Additionally, we plotted summary receiver operating characteristic (SROC) curves and evaluated the areas under the curves (AUC). A total of 16 studies were included in the analysis. Their pooled sensitivity, specificity, PLR, NLR, and DOR of 4D-CT on per-lesion level were 75% (95%CI: 66–82%), 85% (95%CI: 50–97%), 4.9 (95%CI: 1.1–21.3), 0.30 (95%CI: 0.19–0.45), and 17 (95%CI: 3–100), respectively, with an AUC of 81% (95%CI: 77–84%). We also observed heterogeneity in sensitivity (I2 = 79%) and specificity (I2 = 94.7%), and obtained a pooled sensitivity of 81% (95%CI: 70–90%) with heterogeneity of 81.9% (p < 0.001) and PPV of 91% (95%CI: 82–98%) with heterogeneity of 80.8% (p < 0.001), based on a per-patient level. Overall, 4D-CT showed moderate sensitivity and specificity for preoperative localization of HPG(s) in patients with pHPT. The diagnostic performance may improve with 4D-CT’s promotion to first-line use on a lesion-based level, further research is needed to confirm the results.

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