Diagnostic accuracy of urinary reagent strip to determine cerebrospinal fluid chemistry and cellularity

ABSTRACT Background: The gold standard for diagnosis of meningitis depends on cerebrospinal fluid (CSF) examination by microscopy, biochemistry, and culture, which require an experienced microscopist and laboratory support. We conducted this study to determine if urinary reagent strip is useful to make a semi‑quantitative assessment of protein, glucose, and presence of leukocyte esterase in CSF. Materials and Methods: All consecutive CSF samples were evaluated in a blinded fashion. CSF was tested using Combur‑10 urinary reagent strip as an index test, and CSF microscopy and biochemistry as reference standards. Combur‑10 (Boehringer Mannheim) is a urinary reagent strip used to estimate ten parameters including protein, glucose, and leukocytes. We estimated diagnostic accuracy of each index test using corresponding cut‑off levels (glucose 1 + vs. CSF glucose >50 mg/dL; protein 1 + and 2 + vs. CSF protein >30 mg/dL and >100 mg/dL; leukocyte esterase positivity vs. >10 granulocytes in CSF sample). We constructed receiver operating curves (ROC) to evaluate overall performance of index tests and estimated area under the curve (AUC). Results: CSF samples of 75 patients were included in the study. All the three indicator tests (CSF cells, protein, and glucose) were normal in 17 (22.6%) samples. Of the three tests, diagnostic accuracy of protein estimation (1 + or more on reagent strip) was best for detection of CSF proteins greater than 30 mg/dL [sensitivity 98.1% (95% CI 90.1-100%); specificity 57.1% (95% CI 34-78.2%)], with AUC of 0.97. Sensitivity and specificity for 2 + on reagent strip and CSF protein > 100 mg/dL were 92.6% (95% CI 75.1-99.1) and 87.5% (95% CI 74.8-95.3), respectively, with AUC of 0.96 (95% CI 0.92-1.01). Leukocyte esterase positivity by test strip had a sensitivity of 85.2 (95% CI 66.3-95.8%) and specificity of 89.6 (95% CI 77.3-96.5%) for detection of CSF granulocytes of more than 10/mm3. Conclusion: Existing urinary reagent strips can be used to diagnose meningitis in low‑resource settings.

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Determining the degree of accuracy of Combar-10 reagent strip in diagnosing bacterial meningitis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20184304 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2320

Author(s):

Rajkumar D. ◽

Ilangumaran L. ◽

Umashankar A.

Keyword(s):

Bacterial Meningitis ◽

Diagnostic Accuracy ◽

Area Under The Curve ◽

Test Strip ◽

Index Test ◽

Csf Proteins ◽

Overall Performance ◽

Very High ◽

Csf Examination ◽

Experienced Personnel

Background: The gold standard for diagnosis of meningitis depends on cerebrospinal fluid (CSF) examination by microscopy, biochemistry, and culture, which require experienced personnel and laboratory support. We conducted this study to determine if urinary reagent strip is useful to make a semi-quantitative assessment of protein, glucose, and presence of leukocyte esterase in CSF.Methods: All consecutive CSF samples were evaluated in a blinded fashion. CSF was tested using Combur-10 urinary reagent strip as an index test, and CSF microscopy and biochemistry as reference standards. Combur-10 (Boehringer Mannheim) is an urinary reagent strip used to estimate ten parameters including protein, glucose, and leukocytes. We estimated diagnostic accuracy of each index test using corresponding cut-off levels (glucose <1 + vs. CSF glucose <50 mg/dL; protein 2 + and 3 + vs. CSF protein >30 mg/dL and >100 mg/dL; leukocyte esterase positivity vs. >10 granulocytes in CSF sample). We constructed receiver operating curves (ROC) to evaluate overall performance of index tests and estimated area under the curve (AUC).Results: CSF samples of 150 patients were included in the study. Of the three tests, diagnostic accuracy of protein estimation (2+ or more on reagent strip) was best for detection of CSF proteins greater than 50 mg/dL [sensitivity 93.2% (95% CI 86.63-96.67); specificity 91.49% (95% CI 80.07, 96.64)], with AUC of 0.97. Leukocyte esterase positivity by test strip had a sensitivity of 90% (95% CI 82.08, 94.65) and specificity of 91.6% (95% CI 81.93, 96.39) for detection of CSF granulocytes of more than 10/mm3.Conclusions: The degree of accuracy of Combar-10 reagent strip in diagnosing bacterial meningitis is very high similar to CSF microscopy and biochemistry.

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Diagnostic accuracy of fetal MRI to detect cleft palate: a meta-analysis

European Journal of Pediatrics ◽

10.1007/s00431-019-03500-x ◽

2019 ◽

Vol 179 (1) ◽

pp. 29-38 ◽

Cited By ~ 2

Author(s):

Hanneke E. M. van der Hoek-Snieders ◽

Antonius J. M. L. van den Heuvel ◽

Harmieke van Os-Medendorp ◽

Digna M. A. Kamalski

Keyword(s):

At Risk ◽

Diagnostic Accuracy ◽

Cleft Palate ◽

Meta Analysis ◽

Area Under The Curve ◽

Fetal Mri ◽

Diagnostic Study ◽

Index Test ◽

Orofacial Clefts ◽

Prenatal Detection

AbstractThis systematic review aims to determine the diagnostic accuracy of fetal MRI for detecting cleft palate in fetuses at risk for orofacial clefts. Pubmed, Embase, and CINAHL were searched systematically. A diagnostic study was included if it performed MRI (index test) and postnatal examination (reference test) in fetuses at risk for orofacial clefts. Methodological quality was assessed using the QUADAS-2. A meta-analysis was performed with a random-effects model, calculating the pooled sensitivity, specificity, and area under the curve. The search resulted in eight studies (334 fetuses) to be included: four prospective and four retrospective studies. The applicability concern was low. There was, however, a risk of selection and information bias. All studies showed that MRI well predicted the chance of cleft palate. The sensitivity results were homogeneous, but heterogeneity was assumed regarding the specificity estimate (Cochrane’s Q test: p = 0.00). The pooled sensitivity was 0.97 (95% CI 0.93–0.99); the pooled specificity was 0.94 (0.89–0.97). The area under the curve was 0.98 (95% CI 0.98–0.99).Conclusion: This meta-analysis shows that MRI has an excellent sensitivity and good to excellent specificity for diagnosing cleft palate in fetuses at risk for orofacial clefts. Future research should assess applicability for clinical care.What is Known:• Using ultrasound for prenatal detection of cleft palate leads to misdiagnosis frequently.• MRI could potentially improve the prenatal detection rate of cleft palate.What is New:• Eight studies describe the diagnostic accuracy of MRI for detecting cleft palate.• Combined results show excellent sensitivity and good to excellent specificity.

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The shortened combined clonidine and arginine test for growth hormone deficiency is practical and specific: a diagnostic accuracy study

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2015-0284 ◽

2016 ◽

Vol 29 (3) ◽

Cited By ~ 1

Author(s):

Reem Al Khalifah ◽

Lina Moisan ◽

Helen Bui

Keyword(s):

Growth Hormone ◽

Diagnostic Accuracy ◽

Stimulation Index ◽

False Positive Rate ◽

Hormone Deficiency ◽

Index Test ◽

Arginine Test ◽

Positive Rate ◽

Accuracy Study ◽

Index Tests

AbstractThe growth hormone (GH) stimulation protocols for clonidine and arginine tests are non-standardized and can be lengthy. We examined the specificity of both tests using a shorter duration of timed samples: 90 min for clonidine and 60 min for arginine.We retrospectively studied all children who had GH stimulation with clonidine and arginine to test for GH deficiency (GHD). We compared the diagnostic accuracy of both reference and new shortened test (index).We reviewed 243 charts (11.4±4.1 years old; 74.5% males). The combined reference test was performed on 159 children, 29 (18.3%) tested positive for GHD on the combined index test, Kappa 0.98, false positive rate 1 (0.8%), specificity 0.99, 95th CI (0.96–1), and p=1.0. The specificity of both the clonidine and arginine single index tests was 0.98%.The shortened clonidine and arginine stimulation index tests have good specificity. This is a viable option for testing children for GHD.

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Diagnostic Accuracy of Comparative Computed Tomography with Stress Maneuvers for Diagnosing Isolated Syndesmotic Instability in an Acute Ankle Sprain

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00075 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0007

Author(s):

João C. Rodrigues ◽

Alexandre L. Godoy-Santos ◽

Marcelo P. Prado ◽

José Felipe Marion Alloza ◽

Renato do Amaral Masagao ◽

...

Keyword(s):

Computed Tomography ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

External Rotation ◽

Weight Bearing ◽

Correct Diagnosis ◽

Neutral Position ◽

Index Test ◽

Syndesmotic Injury ◽

Index Tests

Category: Ankle; Sports; Trauma Introduction/Purpose: Although there are several imaging options for diagnosing the syndesmotic injury, a fundamental question that guides treatment remains unanswered. Syndesmotic instability is still challenging to diagnose correctly, and syndesmotic disruption and true syndesmotic instability should be differentiated. Currently, imaging tests quickly diagnose severe syndesmotic instability but have difficulty in diagnosing mild and moderate cases. Recently, weight-bearing CT (WB-CT) has emerged as a new modality for the examination of syndesmosis; however, studies have shown that WB-CT is not superior to conventional computed tomography (CT), and axial loading has no benefit for the diagnosis of instability. This study aims to investigate which index test between a CT in a neutral position (CTNP) and a new CT test with stress maneuvers (CTSM) can more accurately diagnose syndesmotic instability. Methods: This diagnostic accuracy-test study consecutively selected individuals older than 18 years with an orthopedic evaluation suspected for acute syndesmotic injury. The accuracy of the index tests (CTNP and CTSM) were examined using magnetic resonance imaging (MRI) as the reference standard. The external rotation and dorsiflexion of the ankle guided the stress maneuvers. Comparison measurements between the injured syndesmosis and the uninjured contralateral side of the same individual investigated syndesmotic instability regarding the translational and rotational relationship between the fibula and tibia. Sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (-LR) value analyzed the diagnostic accuracies of the index tests. Results:: The population included in this study consisted of 64 patients (34 men, 30 women; age range 18-69 years; mean age 35 years). The CTNP exam showed a sensitivity of 18.7% (95% CI, 8 to 35), a specificity of 97% (95% CI, 85 to 99), a +LR of 6.3 (95% CI, 0.8 to 50), and a -LR of 0.8 (95% CI, 0.7 to 0.9). The CTSM exam showed a sensitivity of 91% (95% CI, 76 to 99), a specificity of 94% (95% CI, 80 to 98), a +LR of 15.4 (95% CI, 4 to 59), and a -LR of 0.09 (95% CI, 0.03 to 0.28). The CTSM reflected superior accuracy because the +LR was higher than that of the CTNP, and the confidence interval (CI) for the +LR does not contain 1. Conclusion:: Nevertheless, CTNP is used routinely, this study showed that the test was insufficient for the correct diagnosis, as it presented low sensitivity result. A CTNP with a normal result was not able to exclude syndesmotic instability. The use of the stress maneuver with external rotation and dorsiflexion was a decisive factor for the correct diagnosis, considering that the CTSM exhibited high sensitivity and captured a significantly greater number of true positive cases than the CTNP. This study confirmed CTSM as an accurate method for diagnosing syndesmotic instability and opened a new approach to investigate mild and moderate challenging cases.

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Diagnostic Accuracy of Presepsin (sCD14-ST) for Prediction of Bacterial Infection in Cerebrospinal Fluid Samples from Children with Suspected Bacterial Meningitis or Ventriculitis

Journal of Clinical Microbiology ◽

10.1128/jcm.03052-14 ◽

2015 ◽

Vol 53 (4) ◽

pp. 1239-1244 ◽

Cited By ~ 13

Author(s):

David Stubljar ◽

Andreja Natasa Kopitar ◽

Mojca Groselj-Grenc ◽

Kristina Suhadolc ◽

Teja Fabjan ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

16S Rrna ◽

Bacterial Meningitis ◽

16S Rrna Gene ◽

Diagnostic Accuracy ◽

Bacterial Infection ◽

Area Under The Curve ◽

Rrna Gene ◽

Blood Contamination ◽

Culture Methods

Children with temporary external ventricular drains (EVD) are prone to nosocomial infections. Diagnosis of bacterial meningitis and ventriculitis in these children is challenging due to frequent blood contamination of cerebrospinal fluid (CSF) and the presence of chemical ventriculitis. The aim of this study was to compare diagnostic accuracy of presepsin (sCD14-ST), a novel biomarker of bacterial infection in CSF, to predict bacterial infection in comparison to the accuracy of established biomarkers like those demonstrated in biochemical analysis of CSF. We conducted a prospective study with 18 children with suspected bacterial meningitis or ventriculitis who had 66 episodes of disease. CSF samples were taken from external ventricular drainage. We measured presepsin in CSF, as well as CSF leukocyte count, glucose, and proteins. CSF was also taken to prove bacterial infection with culture methods or with 16S rRNA gene broad-range PCR (SepsiTest; Molzym, Germany). Infection was clinically confirmed in 57 (86%) episodes of suspected meningitis or ventriculitis. Chemical ventriculitis was diagnosed in 9 (14%) episodes of suspected meningitis or ventriculitis. Diagnostic accuracies presented as area under the curve (AUC) for sCD14-ST, leukocytes, and proteins measured in CSF were 0.877 (95% confidence interval [CI], 0.793 to 0.961), 0.798 (95% CI, 0.677 to 0.920), and 0.857 (95% CI, 0.749 to 0.964), respectively. With CSF culture, we detected bacteria in 17 samples, compared to 37 detected with broad-range PCR. It was found that presepsin was present at a significantly higher level in children with clinically proven ventriculitis than in those without meningitis or ventriculitis. Diagnostic accuracies of presepsin were superior to those of leukocytes or proteins in CSF. Presepsin-guided 16S rRNA gene PCR could be used in everyday clinical practice to improve etiological diagnosis of meningitis and ventriculitis and to prescribe more appropriate antibiotics.

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A randomized cross-over trial in patients suspected of PAD on diagnostic accuracy of ankle-brachial index by Doppler-based versus four-point oscillometry based measurements

VASA ◽

10.1024/0301-1526/a000808 ◽

2019 ◽

Vol 48 (6) ◽

pp. 516-522 ◽

Cited By ~ 5

Author(s):

Verena Mayr ◽

Mirko Hirschl ◽

Peter Klein-Weigel ◽

Luka Girardi ◽

Michael Kundi

Keyword(s):

Diagnostic Accuracy ◽

Ankle Brachial Index ◽

Area Under The Curve ◽

High Volume ◽

Epidemiologic Studies ◽

Lower Sensitivity ◽

Oscillometric Device ◽

Specificity And Sensitivity ◽

Time Requirements ◽

Peripheral Arterial

Summary. Background: For diagnosis of peripheral arterial occlusive disease (PAD), a Doppler-based ankle-brachial-index (dABI) is recommended as the first non-invasive measurement. Due to limitations of dABI, oscillometry might be used as an alternative. The aim of our study was to investigate whether a semi-automatic, four-point oscillometric device provides comparable diagnostic accuracy. Furthermore, time requirements and patient preferences were evaluated. Patients and methods: 286 patients were recruited for the study; 140 without and 146 with PAD. The Doppler-based (dABI) and oscillometric (oABI and pulse wave index – PWI) measurements were performed on the same day in a randomized cross-over design. Specificity and sensitivity against verified PAD diagnosis were computed and compared by McNemar tests. ROC analyses were performed and areas under the curve were compared by non-parametric methods. Results: oABI had significantly lower sensitivity (65.8%, 95% CI: 59.2%–71.9%) compared to dABI (87.3%, CI: 81.9–91.3%) but significantly higher specificity (79.7%, 74.7–83.9% vs. 67.0%, 61.3–72.2%). PWI had a comparable sensitivity to dABI. The combination of oABI and PWI had the highest sensitivity (88.8%, 85.7–91.4%). ROC analysis revealed that PWI had the largest area under the curve, but no significant differences between oABI and dABI were observed. Time requirement for oABI was significantly shorter by about 5 min and significantly more patients would prefer oABI for future testing. Conclusions: Semi-automatic oABI measurements using the AngER-device provide comparable diagnostic results to the conventional Doppler method while PWI performed best. The time saved by oscillometry could be important, especially in high volume centers and epidemiologic studies.

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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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Comparison of plasma and cerebrospinal fluid proteomes identifies gene products guiding adult neurogenesis and neural differentiation in birds

Scientific Reports ◽

10.1038/s41598-021-84274-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Eleni Voukali ◽

Nithya Kuttiyarthu Veetil ◽

Pavel Němec ◽

Pavel Stopka ◽

Michal Vinkler

Keyword(s):

Cerebrospinal Fluid ◽

Adult Neurogenesis ◽

Neural Development ◽

Neural Differentiation ◽

Csf Proteins ◽

Nymphicus Hollandicus ◽

Liquid Chromatography Tandem Mass ◽

Genome Information ◽

Insight Into ◽

Brain Homeostasis

AbstractCerebrospinal fluid (CSF) proteins regulate neurogenesis, brain homeostasis and participate in signalling during neuroinflammation. Even though birds represent valuable models for constitutive adult neurogenesis, current proteomic studies of the avian CSF are limited to chicken embryos. Here we use liquid chromatography–tandem mass spectrometry (nLC-MS/MS) to explore the proteomic composition of CSF and plasma in adult chickens (Gallus gallus) and evolutionarily derived parrots: budgerigar (Melopsittacus undulatus) and cockatiel (Nymphicus hollandicus). Because cockatiel lacks a complete genome information, we compared the cross-species protein identifications using the reference proteomes of three model avian species: chicken, budgerigar and zebra finch (Taeniopygia guttata) and found the highest identification rates when mapping against the phylogenetically closest species, the budgerigar. In total, we identified 483, 641 and 458 unique proteins consistently represented in the CSF and plasma of all chicken, budgerigar and cockatiel conspecifics, respectively. Comparative pathways analyses of CSF and blood plasma then indicated clusters of proteins involved in neurogenesis, neural development and neural differentiation overrepresented in CSF in each species. This study provides the first insight into the proteomics of adult avian CSF and plasma and brings novel evidence supporting the adult neurogenesis in birds.

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Diagnostic accuracy of modified Hadlock formula for fetal macrosomia in women with gestational diabetes and pregnancy weight gain above recommended

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0013 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Boris Lovrić ◽

Siniša Šijanović ◽

Joško Lešin ◽

Josip Juras

Keyword(s):

Weight Gain ◽

Gestational Diabetes ◽

Diagnostic Accuracy ◽

Area Under The Curve ◽

Fetal Weight ◽

Pregnancy Weight Gain ◽

Singleton Pregnancy ◽

Time Period ◽

Modified Formula ◽

Pregnancy Weight

Abstract Objectives Women with gestational diabetes (GDM) and weight gain during pregnancy above recommended more often give birth to macrosomic children. The goal of this study was to evaluate the diagnostic accuracy of the modified formula for ultrasound assessment of fetal weight created in a pilot study using a similar specimen in comparison to the Hadlock-2 formula. Methods This is a prospective, cohort, applicative, observational, quantitative, and analytical study, which included 213 pregnant women with a singleton pregnancy, GDM, and pregnancy weight gain above recommended. Participants were consecutively followed in the time period between July 1st, 2016, and August 31st, 2020. Ultrasound estimations were made within three days before the delivery. Fetal weights estimated using both formulas were compared to the newborns’ weights. Results A total of 133 fetal weight estimations were made. In comparison to the newborns’ weight modified formula had significantly smaller deviation in weight estimation compared to the Hadlock-2 formula, higher frequency of deviation within 5% of newborns weights (78.2% [95% CI=0.74–0.83] vs. 60.2%), smaller frequency of deviations from 5 to 10% (19.5 vs. 33.8%) and above 10%, which was even more significant among macrosomic children. There were 36/50 (72%) correctly diagnosed cases of macrosomia by modified and 33/50 (66%) by Hadlock-2 formula. Area under the curve (AUC) for the modified formula was 0.854 (95% CI=0.776–0.932), and for the Hadlock-2 formula 0.824 (95% CI=0.740–0.908). The positive predictive value of the modified formula was 81.81%, the negative 97.91%. Conclusions In cases of greater fetal weights, the modified formula showed greater precision.

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Diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected FAI syndrome: a systematic review

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000772 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000772 ◽

Cited By ~ 2

Author(s):

Rahel Caliesch ◽

Martin Sattelmayer ◽

Stephan Reichenbach ◽

Marcel Zwahlen ◽

Roger Hilfiker

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Index Test ◽

Test Results ◽

Clinical Tests ◽

Negative Test ◽

Post Test ◽

Pincer Morphology ◽

Fai Syndrome ◽

Quality Evidence

ObjectivesTo determine the diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected femoroacetabular impingement (FAI) syndrome and to evaluate their clinical utility.DesignA systematic review of studies investigating the diagnostic accuracy of clinical tests for cam and pincer morphology.Data sourcesPubMed, Embase, CINAHL and SPORTDiscus.Eligibility criteria for selecting studiesStudies investigating the diagnostic accuracy of clinical tests for cam, pincer or mixed morphology in symptomatic patients. Patients had to undergo an index test and a reference test able to identify cam or pincer morphology. Study results have to allow the calculation of true or false positives and/or negatives to calculate sensitivity, specificity, likelihood ratios (LR) and post-test probabilities.ResultsEight studies were included, investigating 17 tests and two test combinations. The studies reported a low specificity for all tests, ranging from 0.11 to 0.56. Sensitivity ranged from 0.11 to 1.00, with high sensitivities for the flexion-adduction-internal rotation (FADIR), foot progression angle walking (FPAW) and maximal squat tests. We estimated that negative test results on all of these three tests would result in a negative LR of 0.15. However, we judged the studies to provide low-quality evidence.ConclusionThere is low-quality evidence that negative test results reduce the post-test probability of cam or mixed morphologies and that consecutive testing with the FADIR, FPAW and maximal squat tests might be used as a clinical test combination. We would not recommend their use to confirm the diagnosis of FAI syndrome.PROSPERO registration numberCRD42018079116.

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