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Journal of Pediatric Orthopedics Jul 2018The purposes of this study were to (1) perform a systematic review of articles that reported agreement or reproducibility in repeated diagnosis of developmental... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The purposes of this study were to (1) perform a systematic review of articles that reported agreement or reproducibility in repeated diagnosis of developmental dysplasia of the hip (DDH) using ultrasound imaging, (2) estimate the reproducibility in the available dysplasia metrics, and (3) compare reproducibility of the available dysplasia metrics.
METHODS
A systematic review of the Medline and Embase databases was performed by using a search strategy formulated from our research question: "For infants at risk of DDH, are US imaging-based diagnoses reproducible?" Two reviewers independently identified articles for inclusion in the systematic review, and then assessed the quality of the included studies using the Guidelines for Reporting Reliability and Agreement Studies guideline. Variability and agreement-related statistics in the included studies were extracted and included in a meta-analysis for summarizing the available statistics. The reproducibility of the available dysplasia metrics was compared, with a Bonferroni correction made to adjust for multiple comparisons.
RESULTS
Twenty eight studies were included in the systematic review. Overall, the quality of the included studies was moderate (average, 10.7/15; range, 6 to 12). Graf's alpha angle had the lowest interexamination variability of the metrics assessed, followed by Graf's beta angle (the variability of the alpha angle was 10% lower than the variability of the beta angle, P<0.05). However, despite Graf's angles having lower variability compared with other dysplasia metrics, their actual variability was still problematically high. This finding was supported by the low intraclass correlation and Kappa coefficient values reported in the included studies. There was also evidence to suggest that the reproducibility in DDH diagnosis has potentially worsened over time.
CONCLUSIONS
Overall, we found high variability and low agreement in all reported dysplasia metrics. Furthermore, in the last 3 decades, the repeatability of dysplasia metrics has not markedly improved and may even have declined, indicating a genuine need for improving repeatability and reliability of ultrasound-based DDH diagnosis.
LEVEL OF EVIDENCE
Level III-systematic review of level III studies.
Topics: Hip Dislocation, Congenital; Humans; Infant; Reproducibility of Results; Ultrasonography
PubMed: 29727411
DOI: 10.1097/BPO.0000000000001179 -
PLoS Neglected Tropical Diseases Mar 2018Diagnosing scrub typhus clinically is difficult, hence laboratory tests play a very important role in diagnosis. As performing sophisticated laboratory tests in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Diagnosing scrub typhus clinically is difficult, hence laboratory tests play a very important role in diagnosis. As performing sophisticated laboratory tests in resource-limited settings is not feasible, accurate point-of-care testing (POCT) for scrub typhus diagnosis would be invaluable for patient diagnosis and management. Here we summarise the existing evidence on the accuracy of scrub typhus POCTs to inform clinical practitioners in resource-limited settings of their diagnostic value.
METHODOLOGY/PRINCIPAL FINDINGS
Studies on POCTs which can be feasibly deployed in primary health care or outpatient settings were included. Thirty-one studies were identified through PubMed and manual searches of reference lists. The quality of the studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). About half (n = 14/31) of the included studies were of moderate quality. Meta-analysis showed the pooled sensitivity and specificity of commercially available immunochromatographic tests (ICTs) were 66.0% (95% CI 0.37-0.86) and 92.0% (95% CI 0.83-0.97), respectively. There was a significant and high degree of heterogeneity between the studies (I2 value = 97.48%, 95% CI 96.71-98.24 for sensitivity and I2 value = 98.17%, 95% CI 97.67-98.67 for specificity). Significant heterogeneity was observed for total number of samples between studies (p = 0.01), study design (whether using case-control design or not, p = 0.01), blinding during index test interpretation (p = 0.02), and QUADAS-2 score (p = 0.01).
CONCLUSIONS/SIGNIFICANCE
There was significant heterogeneity between the scrub typhus POCT diagnostic accuracy studies examined. Overall, the commercially available scrub typhus ICTs demonstrated better performance when 'ruling in' the diagnosis. There is a need for standardised methods and reporting of diagnostic accuracy to decrease between-study heterogeneity and increase comparability among study results, as well as development of an affordable and accurate antigen-based POCT to tackle the inherent weaknesses associated with serological testing.
Topics: Chromatography, Affinity; Humans; Orientia tsutsugamushi; Point-of-Care Testing; Scrub Typhus; Sensitivity and Specificity; Serologic Tests
PubMed: 29579046
DOI: 10.1371/journal.pntd.0006330 -
AJR. American Journal of Roentgenology Feb 2019The objective of our study was to evaluate the diagnostic accuracy of abbreviated biparametric MRI (bpMRI) versus standard multiparametric MRI (mpMRI) for prostate... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
The objective of our study was to evaluate the diagnostic accuracy of abbreviated biparametric MRI (bpMRI) versus standard multiparametric MRI (mpMRI) for prostate cancer (PCa) using guided biopsy or prostatectomy histopathology results as the reference standard.
MATERIALS AND METHODS
A comprehensive literature search of PubMed, Web of Science, and Cochrane Library databases was performed by two researchers independently and the relevant references were assessed. Original research studies comparing bpMRI with mpMRI in diagnosing PCa were included. The methodologic quality of eligible studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Data necessary to complete 2 × 2 contingency tables were obtained to calculate the diagnostic performance of bpMRI and mpMRI using Stata (version 14).
RESULTS
Ten studies were included, and a total of 1705 patients and 3419 lesions were analyzed. Sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio (DOR) of mpMRI in diagnosing PCa were 0.79 (95% CI, 0.69-0.87), 0.89 (95% CI, 0.70-0.96), 6.9 (95% CI, 2.5-18.8), 0.24 (95% CI, 0.16-0.35), and 29 (95% CI, 10-83). Sensitivity, specificity, positive LR, negative LR, and DOR of bpMRI in diagnosing PCa were 0.79 (95% CI, 0.69-0.87), 0.88 (95% CI, 0.73-0.95), 6.4 (95% CI, 2.9-14.5), 0.24 (95% CI, 0.16-0.35), and 27 (95% CI, 11-67). Meta-analysis showed no statistically significant difference between bpMRI and mpMRI for the diagnosis of PCa, and the areas under the summary ROC (SROC) curves were 0.89 and 0.88, respectively (p = 0.9944). Results of the sensitivity analysis were consistent, and the area under the SROC curve for bpMRI and mpMRI was 0.89 for both (p = 0.9349).
CONCLUSION
The available evidence indicates that bpMRI and mpMRI have similar diagnostic efficacy in diagnosing PCa.
Topics: Humans; Magnetic Resonance Imaging; Male; Prostatic Neoplasms; Reproducibility of Results
PubMed: 30512996
DOI: 10.2214/AJR.18.20103 -
Stroke Jan 2014The aim of this study was to evaluate the sensitivity and specificity of MR angiography (MRA) in the diagnosis of ruptured and unruptured intracranial aneurysms. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
The aim of this study was to evaluate the sensitivity and specificity of MR angiography (MRA) in the diagnosis of ruptured and unruptured intracranial aneurysms.
METHODS
A systematic search was performed on 4 electronic databases on relevant articles that were published from January 1998 to October 2013. Inclusion criteria were met by 12 studies that compared MRA with digital subtraction angiography as reference standard. Two independent reviewers evaluated the methodological quality of the studies. Data from eligible studies were extracted and used to construct 2×2 contingency tables on a per-aneurysm level. Pooled estimates of sensitivity and specificity were calculated for all studies and subgroups of studies. Heterogeneity was tested, and risk for publication bias was assessed.
RESULTS
Included studies were of high methodological quality. Studies with larger sample size tended to have higher diagnostic performance. Most studies used time-of-flight MRA technique. Among the 960 patients assessed, 772 aneurysms were present. Heterogeneity with reference to sensitivity and specificity was moderate to high. Pooled sensitivity of MRA was 95% (95% confidence interval, 89%-98%), and pooled specificity was 89% (95% confidence interval, 80%-95%). False-negative and false-positive aneurysms detected on MRA were mainly located at the skull base and middle cerebral artery. Freehand 3-dimensional reconstructions performed by the radiologist significantly increased diagnostic performance. Studies performed on 3 Tesla showed a trend toward higher performance (P=0.054).
CONCLUSIONS
Studies on diagnostic performance of MRA show high sensitivity with large variation in specificity in the detection of intracranial aneurysms.
Topics: Aneurysm, Ruptured; Cerebral Angiography; Data Interpretation, Statistical; False Negative Reactions; False Positive Reactions; Humans; Intracranial Aneurysm; Magnetic Resonance Angiography; ROC Curve; Sample Size; Tomography, X-Ray Computed
PubMed: 24326447
DOI: 10.1161/STROKEAHA.113.003133 -
Academic Emergency Medicine : Official... Jun 2013Small bowel obstruction (SBO) is a clinical condition that is often initially diagnosed and managed in the emergency department (ED). The high rates of potential... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Small bowel obstruction (SBO) is a clinical condition that is often initially diagnosed and managed in the emergency department (ED). The high rates of potential complications that are associated with an SBO make it essential for the emergency physician (EP) to make a timely and accurate diagnosis.
OBJECTIVES
The primary objective was to perform a systematic review and meta-analysis of the history, physical examination, and imaging modalities associated with the diagnosis of SBO. The secondary objectives were to identify the prevalence of SBO in prospective ED-based studies of adult abdominal pain and to apply Pauker and Kassirer's threshold approach to clinical decision-making to the diagnosis and management of SBO.
METHODS
MEDLINE, EMBASE, major emergency medicine (EM) textbooks, and the bibliographies of selected articles were scanned for studies that assessed one or more components of the history, physical examination, or diagnostic imaging modalities used for the diagnosis of SBO. The selected articles underwent a quality assessment by two of the authors using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data used to compile sensitivities and specificities were obtained from these studies and a meta-analysis was performed on those that examined the same historical component, physical examination technique, or diagnostic test. Separate information on the prevalence and management of SBO was used in conjunction with the meta-analysis findings of computed tomography (CT) to determine the test and treatment threshold.
RESULTS
The prevalence of SBO in the ED was determined to be approximately 2% of all patients who present with abdominal pain. Having a previous history of abdominal surgery, constipation, abnormal bowel sounds, and/or abdominal distention on examination were the best history and physical examination predictors of SBO. X-ray was determined to be the least useful imaging modality for the diagnosis of SBO, with a pooled positive likelihood ratio (+LR) of 1.64 (95% confidence interval [CI] = 1.07 to 2.52). On the other hand, CT and magnetic resonance imaging (MRI) were both quite accurate in diagnosing SBO with +LRs of 3.6 (5- to 10-mm slices, 95% CI = 2.3 to 5.4) and 6.77 (95% CI = 2.13 to 21.55), respectively. Although limited to only a select number of studies, the use of ultrasound (US) was determined to be superior to all other imaging modalities, with a +LR of 14.1 (95% CI = 3.57 to 55.66) and a negative likelihood ratio (-LR) of 0.13 (95% CI = 0.08 to 0.20) for formal scans and a +LR of 9.55 (95% CI = 2.16 to 42.21) and a -LR of 0.04 (95% CI = 0.01 to 0.13) for beside scans. Using the CT results of the meta-analysis for the 5- to 10-mm slice subgroup as well as information on intravenous (IV) contrast reactions and nasogastric (NG) intubation management, the pretest probability threshold for further testing was determined to be 1.5%, and the pretest probability threshold for beginning treatment was determined to be 20.7%.
CONCLUSIONS
The potentially useful aspects of the history and physical examination were limited to a history of abdominal surgery, constipation, and the clinical examination findings of abnormal bowel sounds and abdominal distention. CT, MRI, and US are all adequate imaging modalities to make the diagnosis of SBO. Bedside US, which can be performed by EPs, had very good diagnostic accuracy and has the potential to play a larger role in the ED diagnosis of SBO. More ED-focused research into this area will be necessary to bring about this change.
Topics: Adult; Emergency Medical Services; Four-Dimensional Computed Tomography; Humans; Intestinal Obstruction; Intestine, Small; Magnetic Resonance Angiography; Physical Examination; Prospective Studies; Ultrasonography, Doppler
PubMed: 23758299
DOI: 10.1111/acem.12150 -
Arab Journal of Gastroenterology : the... Jun 2013Fibroscan and APRI are promising noninvasive alternatives to liver biopsy for detecting hepatic fibrosis. However, their overall test performance in various settings... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND AND STUDY AIMS
Fibroscan and APRI are promising noninvasive alternatives to liver biopsy for detecting hepatic fibrosis. However, their overall test performance in various settings remains questionable. The aim of our study was to perform a systematic review and meta-analysis of diagnostic accuracy studies comparing fibroscan and APRI with liver biopsy for hepatic fibrosis.
PATIENTS AND METHODS
Electronic and manual bibliographic searches to identify potential studies were performed. Selection of studies was based on reported accuracy of fibroscan and APRI compared with liver biopsy. Data extraction was performed independently by two reviewers. Meta-analysis combined the sensitivities, specificities, and likelihood ratios of individual studies. Extent and reasons for heterogeneity were assessed.
RESULTS
23 studies for fibroscan and 20 studies for APRI in full publication were identified. For patients with stage IV fibrosis (cirrhosis), the pooled estimates for sensitivity of fibroscan were 83.4% (95% confidence interval [CI], 71.7-95.0%) and specificity 92.4% (95% CI, 85.6-99.2%). For patients with stage IV fibrosis (cirrhosis), the pooled estimates for sensitivity of APRI at cutoff point of 1.5 were 66.5% (95% CI, 25.0-100%) and specificity 71.7% (95% CI, 35.0-100%). Diagnostic threshold bias was identified as an important cause of heterogeneity for pooled results in both patient groups.
CONCLUSIONS
Fibroscan and APRI appear to be clinically useful tests for detecting cirrhosis however not useful tools in early stages of fibrosis.
Topics: Aspartate Aminotransferases; Biopsy, Needle; Elasticity Imaging Techniques; Humans; Liver; Liver Cirrhosis; Platelet Count; Semustine
PubMed: 23820499
DOI: 10.1016/j.ajg.2013.05.002 -
Journal of Nuclear Medicine : Official... Feb 2012For the past decade, PET with (18)F-fluoro-ethyl-tyrosine ((18)F-FET) has been used in the evaluation of patients with primary brain tumors (PBTs), but so far series... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
For the past decade, PET with (18)F-fluoro-ethyl-tyrosine ((18)F-FET) has been used in the evaluation of patients with primary brain tumors (PBTs), but so far series have reported only a limited number of patients. The purpose of this systematic review and metaanalysis was to assess the diagnostic performance of (18)F-FET PET in patients with suspicion of PBT.
METHODS
We examined studies published in the literature using MEDLINE and EMBASE databases. Inclusion criteria were use of (18)F-FET PET for initial assessment of patients with a newly diagnosed brain lesion; patients who had no radiotherapy, surgery, or chemotherapy before (18)F-FET PET; and use of histology as a gold standard. Metaanalysis was performed on a per-patient basis. We secondarily performed receiver-operating-characteristic analysis of pooled patients to determine tumor-to-background ratio (TBR) of (18)F-FET uptake and best diagnostic value.
RESULTS
Thirteen studies totaling 462 patients were included. For the diagnosis of PBT, (18)F-FET PET demonstrated a pooled sensitivity of 0.82 (95% confidence interval [CI], 0.74-0.88), specificity of 0.76 (95% CI, 0.44-0.92), area under the curve of 0.84 (95% CI, 0.80-0.87), positive likelihood ratio of 3.4 (95% CI, 1.2-9.5), and negative likelihood ratio of 0.24 (95% CI, 0.14-0.39). Receiver-operating-characteristic analysis indicated that a mean TBR threshold of at least 1.6 and a maximum TBR of at least 2.1 had the best diagnostic value for differentiating PBTs from nontumoral lesions.
CONCLUSION
(18)F-FET PET demonstrated excellent performance for diagnosing PBTs. Strict standardization of PET acquisition protocols and prospective, multicenter studies investigating the added value over current MRI are now needed to establish (18)F-FET PET as a highly relevant tool for patient management.
Topics: Animals; Brain Neoplasms; Diagnosis, Differential; Glioma; Humans; Positron-Emission Tomography; Quality Control; Tyrosine
PubMed: 22302961
DOI: 10.2967/jnumed.111.096859 -
World Journal of Surgery Jul 2017Clinical prediction rules (CPRs) provide an objective method of assessment in the diagnosis of acute appendicitis. There are a number of available CPRs for the diagnosis... (Review)
Review
BACKGROUND
Clinical prediction rules (CPRs) provide an objective method of assessment in the diagnosis of acute appendicitis. There are a number of available CPRs for the diagnosis of appendicitis, but it is unknown which performs best.
AIM
The aim of this study was to identify what CPRs are available and how they perform when diagnosing appendicitis in adults.
METHOD
A systematic review was performed in accordance with the PRISMA guidelines. Studies that derived or validated a CPR were included. Their performance was assessed on sensitivity, specificity and area under curve (AUC) values.
RESULTS
Thirty-four articles were included in this review. Of these 12 derived a CPR and 22 validated these CPRs. A narrative analysis was performed as meta-analysis was precluded due to study heterogeneity and quality of included studies. The results from validation studies showed that the overall best performer in terms of sensitivity (92%), specificity (63%) and AUC values (0.84-0.97) was the AIR score but only a limited number of studies investigated at this score. Although the Alvarado and Modified Alvarado scores were the most commonly validated, results from these studies were variable. The Alvarado score outperformed the modified Alvarado score in terms of sensitivity, specificity and AUC values.
CONCLUSION
There are 12 CPRs available for diagnosis of appendicitis in adults. The AIR score appeared to be the best performer and most pragmatic CPR.
Topics: Adult; Appendicitis; Area Under Curve; Decision Support Techniques; Humans
PubMed: 28258458
DOI: 10.1007/s00268-017-3926-6 -
Academic Emergency Medicine : Official... Mar 2011The authors sought to determine the diagnostic test characteristics of bedside emergency physician (EP)-performed ultrasound (US) for cholelithiasis in symptomatic... (Review)
Review
OBJECTIVES
The authors sought to determine the diagnostic test characteristics of bedside emergency physician (EP)-performed ultrasound (US) for cholelithiasis in symptomatic emergency department (ED) patients.
METHODS
A search was conducted of MEDLINE, EMBASE, the Cochrane Library, bibliographies of previous systematic reviews, and abstracts from major emergency medicine conference proceedings. We included studies that prospectively assessed the diagnostic accuracy of emergency US (EUS) for cholelithiasis, compared to a criterion reference standard of radiology-performed ultrasound (RADUS), computed tomography (CT), magnetic resonance imaging (MRI), or surgical findings. Two authors independently performed relevance screening of titles and abstracts, extracted data, and performed the quality analysis. Disagreements were resolved by conference between the two reviewers. EUS performance was assessed with summary receiver operator characteristics curve (SROC) analysis, with independently pooled sensitivity and specificity values across included studies.
RESULTS
The electronic search yielded 917 titles; eight studies met the inclusion criteria, yielding a sample of 710 subjects. All included studies used appropriate selection criteria and reference standards, but only one study reported uninterpretable or indeterminate results. The pooled estimates for sensitivity and specificity were 89.8% (95% confidence interval [CI] = 86.4% to 92.5%) and 88.0% (95% CI = 83.7% to 91.4%), respectively.
CONCLUSIONS
This study suggests that in patients presenting to the ED with pain consistent with biliary colic, a positive EUS scan may be used to arrange for appropriate outpatient follow-up if symptoms have resolved. In patients with a low pretest probability, a negative EUS scan should prompt the clinician to consider an alternative diagnosis.
Topics: Cholelithiasis; Diagnosis, Differential; Emergency Medicine; Emergency Service, Hospital; Humans; Point-of-Care Systems; ROC Curve; Sensitivity and Specificity; Ultrasonography
PubMed: 21401784
DOI: 10.1111/j.1553-2712.2011.01012.x -
AJR. American Journal of Roentgenology Nov 2018The purpose of this study was to perform a systematic review and meta-analysis of a head-to-head comparison between the performance of biparametric MRI (bpMRI; only... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of this study was to perform a systematic review and meta-analysis of a head-to-head comparison between the performance of biparametric MRI (bpMRI; only T2-weighted imaging and DWI) and that of multiparametric MRI (mpMRI; T2-weighted imaging, DWI, dynamic contrast-enhanced MRI) for the diagnosis of prostate cancer.
MATERIALS AND METHODS
The PubMed and Embase databases were searched up to November 11, 2017. The search included diagnostic test accuracy studies that compared bpMRI and mpMRI for prostate cancer diagnosis with histopathologic findings from biopsy or radical prostatectomy as the reference standard. Methodologic quality was evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies tool. Sensitivity and specificity were pooled by means of bivariate and hierarchic summary ROC (HSROC) modeling and graphically presented with HSROC plots. Meta-regression analysis and multiple subgroup analyses were used to compare the diagnostic performances of bpMRI and mpMRI.
RESULTS
Twenty studies (2142 patients) were included. Pooled sensitivity and specificity were 0.74 (95% CI, 0.66-0.81) and 0.90 (95% CI, 0.86-0.93) for bpMRI and 0.76 (95% CI, 0.69-0.82) and 0.89 (95% CI, 0.85-0.93) for mpMRI. MRI protocol (bpMRI vs mpMRI) was not a significant factor in heterogeneity (p = 0.83). In 26 subgroups evaluated on the basis of stratification to clinicopathologic, study, and MRI characteristics, MRI protocol (bpMRI vs mpMRI) was not a significant factor in heterogeneity in any subgroup (p = 0.25-0.97).
CONCLUSION
A head-to-head comparison showed that the performance of bpMRI was similar to that of mpMRI in the diagnosis of prostate cancer. Consistent results were found in multiple subgroup analyses.
Topics: Contrast Media; Humans; Magnetic Resonance Imaging; Male; Prostatic Neoplasms
PubMed: 30240296
DOI: 10.2214/AJR.18.19880