scholarly journals The diagnostic and predictive accuracy of thyroglobulin to TSH ratio and TSH to thyroglobulin ratio in detecting differentiated thyroid carcinoma in normothyroid patients with thyroid nodules: A retrospective cohort study and systematic review of the literature

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Evangelos Karvounis ◽  
Ioannis Kappas ◽  
Anna Angelousi ◽  
George-Marios Makris ◽  
Thomas D. Siamatras ◽  
...  
Keyword(s):  
Cohort Study ◽  
Diagnostic Accuracy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Thyroid Nodules ◽  
Predictive Accuracy ◽  
Predictive Marker ◽  
Thyroid Stimulating Hormone ◽  
Benign Disease ◽  
International Literature

The purpose of the present study is to examine the diagnostic and predictive accuracy of the thyroglobulin (Tg) to thyroid stimulating hormone (TSH) and TSH/Tg ratios in normothyroid patients with differentiated thyroid cancer (DTC). We conducted a retrospective cohort study evaluating the diagnostic accuracy of the serum Tg/TSH and TSH/Tg ratios in normothyroid patients with thyroid nodules. We also systematically searched the international literature using the Medline, Cochrane’s CENTRAL, Scopus, Clinicaltrials.gov, EMBASE, and Google Scholar databases for evidence concerning the diagnostic and predictive accuracy of these ratios. Overall, 374 patients were identified in our cohort study of whom 240 were treated for benign disease and 134 were treated for DTC. Significant differences were noted in the Tg/TSH and TSH/Tg values among cases with malignant and benign disease (P=0.020). However, the diagnostic ROC curve did not confirm these results (Tg/TSH=0.572 and TSH/Tg=0.428). After searching the international literature, we identified 8 studies. The majority of the included data reported significant differences among patients with benign/malignant disease and those with successful iodine therapy compared to those with disease relapse. However, the clinical relevance was clearer among studies that investigated the usefulness of these ratios in predicting recurrent disease. The findings of our study support that the Tg/TSH ratio increases in patients with DTC and can, thus, become useful in the future as a predictive marker of ablative 131I therapy success. However, given the significant variability of Tg its diagnostic accuracy remains to date minimal; thus, the actual cut-off value that can be used to discriminate cancer cases from benign disease has not been determined yet.

scholarly journals External validation of the detection of indicators and vulnerabilities for emergency room trips (DIVERT) scale: a retrospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Fabrice I. Mowbray ◽  
Aaron Jones ◽  
Connie Schumacher ◽  
John Hirdes ◽  
Andrew P. Costa
Keyword(s):  
Cohort Study ◽  
Home Care ◽  
Emergency Room ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Reporting System ◽  
Predictive Accuracy ◽  
External Validation ◽  
Discriminative Ability ◽  
Geographical Regions

Abstract Background The Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) scale was developed to classify and estimate the risk of emergency department (ED) use among home care clients. The objective of this study was to externally validate the DIVERT scale in a secondary population of home care clients. Methods We conducted a retrospective cohort study, linking data from the Home Care Reporting System and the National Ambulatory Care Reporting System. Data were collected on older long-stay home care clients who received a RAI Home Care (RAI-HC) assessment. Data were collected for home care clients in the Canadian provinces of Ontario and Alberta, as well as in the cities of Winnipeg, Manitoba and Whitehorse, Yukon Territories between April 1, 2011 and September 30, 2014. The DIVERT scale was originally derived from the items of the RAI-HC through the use of recursive partitioning informed by a multinational clinical panel. This scale is currently implemented alongside the RAI-HC in provinces across Canada. The primary outcome of this study was ED visitation within 6 months of a RAI-HC assessment. Results The cohort contained 1,001,133 home care clients. The vast majority of cases received services in Ontario (88%), followed by Alberta (8%), Winnipeg (4%), and Whitehorse (< 1%). Across the four cohorts, the DIVERT scale demonstrated similar discriminative ability to the original validation work for all outcomes during the six-month follow-up: ED visitation (AUC = 0.617–0.647), two or more ED visits (AUC = 0.628–0.634) and hospital admission (AUC = 0.617–0.664). Conclusions The findings of this study support the external validity of the DIVERT scale. More specifically, the predictive accuracy of the DIVERT scale from the original work was similar to the accuracy demonstrated within a new cohort, created from different geographical regions and time periods.

scholarly journals Patterns of Thyroid Hormone Prescription in Patients with Bipolar or Schizoaffective Disorder: Findings from the LiSIE Retrospective Cohort Study

2021 ◽  
Vol 10 (21) ◽  
pp. 5062
Author(s):  
Ingrid Lieber ◽  
Michael Ott ◽  
Louise Öhlund ◽  
Robert Lundqvist ◽  
Mats Eliasson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Thyroid Hormone ◽  
Schizoaffective Disorder ◽  
Subclinical Hypothyroidism ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hormone Replacement ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Thyroid Hormone Replacement Therapy

The prescription of thyroid hormone replacement therapy (THRT) has increased in the general population; the thyroid stimulating hormone (TSH) threshold to initiate THRT has decreased. It remains unclear whether a similar trend has occurred in patients with bipolar disorder (BD). In this work we explore patterns and trends of prescribing THRT in patients with BD or schizoaffective disorder (SZD) with an observational study and time-trend analysis in the framework of the LiSIE (Lithium—Study into Effects and Side Effects) retrospective cohort study. In most patients, THRT was initiated for subclinical hypothyroidism. The median TSH at which THRT was started was 6.0 (IQR 4.0) mIU/L and the median free serum thyroxine (fT4) at which THRT was started was 11.8 (IQR 3.9) pmol/L. The median TSH concentration at the start of THRT decreased annually with 0.10 mIU/L (p = 0.047) and was higher in patients treated with lithium than in patients treated with other mood stabilisers (p = 0.02). In conclusion, THRT was typically initiated in the context of mild or absent alterations of thyroid function tests with a decreasing TSH threshold. As THRT is rarely reversed once initiated, clinicians need to weigh up potential benefits and risks when prescribing THRT for subclinical hypothyroidism in patients with BD or SZD.

scholarly journals External Validation of the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Fabrice Immanuel Mowbray ◽  
Aaron Jones ◽  
Connie Schumacher ◽  
John Hirdes ◽  
Andrew Paul Costa
Keyword(s):  
Cohort Study ◽  
Home Care ◽  
Emergency Room ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Reporting System ◽  
Predictive Accuracy ◽  
External Validation ◽  
Discriminative Ability ◽  
Geographical Regions

Abstract Background: The Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) scale was developed to classify and estimate the risk of emergency department (ED) use in home care clients. The objective of this study was to externally validate the DIVERT scale in a secondary population of home care clients.Methods: We conducted a retrospective cohort study, linking data from the Home Care Reporting System and the National Ambulatory Care Reporting System. Data were collected on older long-stay home care clients who received a RAI Home Care (RAI-HC) assessment. Data were collected for home care clients in the Canadian provinces of Ontario and Alberta, as well as in the cities of Winnipeg, Manitoba and Whitehorse, Yukon Territories, between April 1, 2011 and September 30, 2014. The DIVERT Scale was originally derived from the items of the RAI-HC through the use of recursive partitioning informed by a multinational clinical panel. This scale is currently implemented alongside the RAI-HC in provinces across Canada. The primary outcome of this study was an ED visit within six months of a RAI-HC assessment.Results: The cohort contained 1,001,133 home care clients. The vast majority of cases received services in Ontario (88%), followed by Alberta (8%), Winnipeg (4%), and Whitehorse (<1%). Across the four cohorts, the DIVERT scale demonstrated similar discriminative ability to the original validation work for all outcomes during the six-month follow-up: ED visitation (AUC =0.617-0.647), two or more ED visits (AUC = 0.628-0.634), and hospital admission (AUC = 0.617-0.664).Conclusions: The findings of this study support the external validity of the DIVERT scale. More specifically, the predictive accuracy of the DIVERT scale from the original work was similar to the accuracy demonstrated within a new cohort, created from different geographical regions and time periods.

scholarly journals The Brighton Spondylodiscitis Score Does Not Accurately Predict the Need for Surgery: A Retrospective Cohort Study in New Zealand

2021 ◽  
pp. 219256822198929
Author(s):  
Sarah Hunter ◽  
Hasanga Fernando ◽  
Joseph F. Baker
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Surgical Intervention ◽  
Predictive Accuracy ◽  
External Validation ◽  
Population Characteristics ◽  
Calibration Plot ◽  
Pyogenic Spondylodiscitis

Study Design: Retrospective cohort study. Objectives: Despite pyogenic spondylodiscitis potentially conferring significant morbidity, there is no consensus on optimal treatment. The Brighton Spondylodiscitis Score (BSDS) was developed to identify patients who would likely fail conservative management and therefore benefit from earlier surgical intervention. In this study, we attempt external validation of the BSDS. Methods: We carried out a retrospective review of all patients treated at our institution, 2010-2016, for pyogenic spondylodiscitis. 91 met inclusion criteria and 40 progressed to require surgical intervention. The BSDS was calculated for each patient allowing stratification into low-, moderate- and high-risk groups. Calibration and discrimination was assessed with ROC curve analysis and calibration plot. Results: Area under the curve (AUC) was 0.469 (0.22-0.71) in our external validation, compared with AUC 0.83 and 0.71 (CI 0.50-0.88) in the original study and test populations respectively. Only 60% of patients in the high-risk group required surgery, 50% in the moderate, and 38% of the low indicating poor calibration and predictive accuracy. Operative intervention was not higher overall in our cohort (44% vs. 32%, p = 0.14). We found greater rates of bacteraemia, more distal infection, and more advanced MRI findings in our cohort. The incidence of spondylodiscitis in our region is higher (4/100 000/year). Conclusion: We failed to externally validate the BSDS in our population which is likely a result of unique population characteristics and the inherently variable pathology associated with spondylodiscitis. Clinicians must be cautious in adopting treatment algorithms developed in other health care systems that may comprise significantly different patient and pathogen characteristics.

scholarly journals External Validation of the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Fabrice Immanuel Mowbray ◽  
Aaron Jones ◽  
Connie Schumacher ◽  
John Hirdes ◽  
Andrew Paul Costa
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Home Care ◽  
Emergency Room ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Reporting System ◽  
Predictive Accuracy ◽  
External Validation ◽  
Geographical Regions

Abstract Background: The Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) scale was developed to classify and estimate the risk of emergency department (ED) use in home care clients. The objective of this study was to externally validate the DIVERT scale in a secondary population of home care clients. Methods: We conducted a retrospective cohort study, linking data from the Home Care Reporting System and the National Ambulatory Care Reporting System. Data were collected on older long-stay home care clients who received a RAI Home Care (RAI-HC) assessment. Data were collected for home care clients in the Canadian provinces of Ontario and Alberta, as well as in the cities of Winnipeg, Manitoba and Whitehorse, Yukon Territories, between April 1, 2011 and September 30, 2014. The DIVERT Scale was originally derived from the items of the RAI-HC through the use of recursive partitioning informed by a multinational clinical panel. This scale is currently implemented alongside the RAI-HC in provinces across Canada. The primary outcome of this study was an ED visit within six months of a RAI-HC assessment. Results: The cohort contained 1,001,133 home care clients. The vast majority of cases received services in Ontario (88%), followed by Alberta (8%), Winnipeg (4%), and Whitehorse (<1%). Across the four cohorts, the DIVERT scale demonstrated similar discriminative ability to the original validation work for all outcomes during the six-month follow-up: ED visitation (AUC =0.617-0.647), two or more ED visits (AUC = 0.628-0.634), and hospital admission (AUC = 0.617-0.664). Conclusions: The findings of this study support the external validity of the DIVERT scale. More specifically, the predictive accuracy of the DIVERT scale from the original work was similar to the accuracy demonstrated within a new cohort, created from different geographical regions and time periods. Key Words : Home Care, Emergency Department, Geriatrics, DIVERT

scholarly journals Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study

2021 ◽  
Vol 10 (22) ◽  
pp. 5248
Author(s):  
Naoki Yogo ◽  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Masayasu Gakumazawa ◽  
Mafumi Shinohara ◽  
...  
Keyword(s):  
Cohort Study ◽  
Head Injury ◽  
Diagnostic Accuracy ◽  
Decision Rule ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Characteristic Curve ◽  
Clinical Decision ◽  
The Novel ◽  
Clinical Decision Rule

Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its diagnostic accuracy in identifying children with clinically important traumatic brain injury (ciTBI). We selected predictors based on three existing CDRs: CATCH, CHALICE, and PECARN. Of the 2569 eligible patients, 645 (439 (68%) boys, median age: five years) were included in this study. In total, 59 (9%) patients showed ciTBI, and 129 (20%) were admitted to hospital. The novel CDR comprised six predictors of abnormal CT findings. It had a sensitivity of 79.5% (95% confidence interval (CI): 65.5–89.0%) and a specificity of 50.9% (95% CI: 48.9–52.3%). The area under the receiver-operating characteristic curve (0.72, 95% CI: 0.67–0.77) was non-inferior to those of CATCH, CHALICE, and PECARN (0.71, 95% CI: 0.66–0.77; 0.67, 95% CI: 0.61–0.74; and 0.69, 95% CI: 0.64–0.73, respectively; p = 0.57). The novel CDR was statistically noninferior in diagnostic accuracy compared to the three existing CDRs. Further development and validation studies are needed before clinical application.

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