Systematic Review With Meta-Analyses and Critical Appraisal of Clinical Prediction Rules for Pulmonary Tuberculosis in Hospitals

2014 ◽  
Vol 36 (2) ◽  
pp. 204-213 ◽  
Author(s):  
Berenice das Dores Gonçalves ◽  
Sonia Regina Lambert Passos ◽  
Maria Angelica Borges dos Santos ◽  
Carlos Augusto Ferreira de Andrade ◽  
Maria de Fátima Moreira Martins ◽  
...  
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Pulmonary Tuberculosis ◽  
Chest Radiograph ◽  
Validation Studies ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Clinical Prediction ◽  
Prediction Rules ◽  
Meta Analyses

ObjectiveTo systematically review studies evaluating clinical prediction rules (CPRs) for adult inpatients suspected to have pulmonary tuberculosis.DesignSystematic review with meta-analyses.SettingHospitals.PatientsInpatients at least 15 years of age admitted to acute care.MethodsA search was conducted in 5 indexed electronic databases with no language or year of publication restrictions. We performed a meta-analysis for those CPRs with at least 2 validation studies. Results were reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.ResultsOf the 461 abstracts selected, 36 articles were fully analyzed and 11 articles were included, yielding 8 CPRs derived in 4 countries. Broad validation studies were identified for 2 CPRs. The most frequent clinical predictors were fever and weight loss. All CPRs included chest imaging signs. Most CPRs were derived in countries with a low prevalence of pulmonary tuberculosis and included homeless, immigrants, and those who reacted to the purified protein derivative test. Both of the CPRs derived in countries with a high prevalence of pulmonary tuberculosis strongly relied on chest radiograph predictors. Accuracy of the different CPRs was high (area under receiver operating characteristic curve, 0.79–0.91). Meta-analysis of 4 validation studies for Wisnivesky´s CPR indicates optimistic pooled results: sensitivity, 94.1% (95% CI, 89.7%–96.7%); negative likelihood ratio, 0.22 (95% CI, 0.12–0.40).ConclusionOn the basis of a critical appraisal of the 2 best validated CPRs, the presence of weight loss and/or fever in inpatients warrants obtaining a chest radiograph, regardless of the presence of productive cough. If the chest radiograph is abnormal, the patient should be placed in isolation until more specific test results are available. Validation in different settings is required to maximize external generalization of existing CPRs.Infect Control Hosp Epidemiol 2014;00(0): 1–10

scholarly journals P142: Diagnosis of pulmonary embolism in the Canadian context: clinical review findings from a health technology assessment

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S107-S107
Author(s):  
A. Sinclair ◽  
K. Peprah ◽  
T. Quay ◽  
S. Mulla ◽  
L. Weeks
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Diagnostic Imaging ◽  
Laboratory Testing ◽  
Meta Analysis ◽  
Health Technology ◽  
Clinical Prediction ◽  
Prediction Rules ◽  
Canadian Context ◽  
D Dimer

Introduction: Pulmonary embolism (PE) is a diagnostic challenge, since it shares symptoms with other conditions. Missed diagnosis puts patients at a risk of a potentially fatal outcome, while false positive results leave them at risk of side effects (bleeding) from unnecessary treatment. Diagnosis involves a multi-step pathway consisting of clinical prediction rules (CPRs), laboratory testing, and diagnostic imaging, but the best strategy in the Canadian context is unclear. Methods: We carried out a systematic review of the diagnostic accuracy, clinical utility, and safety of diagnostic pathways, CPRs, and diagnostic imaging for the diagnosis of PE. Clinical prediction rules were studied by an overview of systematic reviews, and pathways and diagnostic imaging by a primary systematic review. Where feasible, a diagnostic test meta-analysis was conducted, with statistical adjustment for the use of variable and imperfect reference standards across studies. Results: The Wells CPR rule showed greater specificity than the Geneva, but the relative sensitivities were undetermined. Application of a CPR followed by with D-dimer laboratory testing can safely rule out PE. In diagnostic test accuracy meta-analysis, computed tomography (CT) (sensitivity 0.973, 95% CrI 0.921 to 1.00) and ventilation/perfusion single-photon emission CT (VQ-SPECT) (sensitivity 0.974, 95% CrI 0.898 to 1.00) had the highest sensitivity) and CT the highest specificity (0.987, 95% CrI 0.958 to 1.00). VQ and VQ-SPECT had a higher proportion of indeterminate studies, while VQ and VQ-SPECT involved lower radiation exposure than CT. Conclusion: CPR and D-dimer testing can be used to avoid unnecessary imaging. CT is the most accurate single modality, but radiation risk must be assessed. These findings, in conjunction with a recent health technology assessment, may help to inform clinical practice and guidelines.

scholarly journals Validity of ultrasonography to diagnosing pneumothorax: a critical appraisal of two meta-analyses

CJEM ◽  
2015 ◽  
Vol 17 (2) ◽  
pp. 199-201 ◽  
Author(s):  
Aftab Azad ◽  
Saad Al Juma ◽  
Junaid A. Bhatti ◽  
Jerrald Dankoff
Keyword(s):  
Systematic Review ◽  
Chest Radiography ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Clinical Question ◽  
Test Characteristics ◽  
Meta Analyses

Clinical questionCan ultrasonography be used in lieu of chest radiography to diagnose pneumothorax?Articles chosen1. Ding W, Shen Y, Yang J, et al. Diagnosis of pneumothorax by radiography and ultrasonography: a metaanalysis. Chest 2011;140:859-66. [Epub 2011 May 5]2. Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest 2012; 141:703-8.

C0302 Prognostic clinical prediction rules to identify low-risk pulmonary embolism: A systematic review and meta-analysis

2012 ◽  
Vol 130 ◽  
pp. S125
Author(s):  
Alessandro Squizzato ◽  
Marco P. Donadini ◽  
Luca Galli ◽  
Francesco Dentali ◽  
Drahomir Aujesky ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Meta Analysis ◽  
Low Risk ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules

scholarly journals Diagnostic value of biomarkers for paediatric urinary tract infections in primary care: systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hanne A. Boon ◽  
Thomas Struyf ◽  
Dominique Bullens ◽  
Ann Van den Bruel ◽  
Jan Y. Verbakel
Keyword(s):  
Systematic Review ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Meta Analysis ◽  
Clinical Prediction ◽  
C Reactive Protein ◽  
Dipstick Test ◽  
Prediction Rules ◽  
Reactive Protein ◽  
Tract Infections

Abstract Background Accurate diagnosis of urinary tract infection is essential as children left untreated may suffer permanent renal injury. Aim To compare the diagnostic values of biomarkers or clinical prediction rules for urinary tract infections in children presenting to ambulatory care. Design and setting Systematic review and meta-analysis of ambulatory care studies. Methods Medline, Embase, WOS, CINAHL, Cochrane library, HTA and DARE were searched until 21 May 2021. We included diagnostic studies on urine or blood biomarkers for cystitis or pyelonephritis in children below 18 years of age. We calculated sensitivity, specificity and likelihood ratios. Data were pooled using a bivariate random effects model and a Hierarchical Summary Receiver Operating Characteristic analysis. Results Seventy-five moderate to high quality studies were included in this review and 54 articles in the meta-analyses. The area under the receiver-operating-characteristics curve to diagnose cystitis was 0.75 (95%CI 0.62 to 0.83, n = 9) for C-reactive protein, 0.71 (95% CI 0.62 to 0.80, n = 4) for procalcitonin, 0.93 (95% CI 0.91 to 0.96, n = 22) for the dipstick test (nitrite or leukocyte esterase ≥trace), 0.94 (95% CI 0.58 to 0.98, n = 9) for urine white blood cells and 0.98 (95% CI 0.92 to 0.99, n = 12) for Gram-stained bacteria. For pyelonephritis, C-reactive protein < 20 mg/l had LR- of 0.10 (95%CI 0.04–0.30) to 0.22 (95%CI 0.09–0.54) in children with signs suggestive of urinary tract infection. Conclusions Clinical prediction rules including the dipstick test biomarkers can support family physicians while awaiting urine culture results. CRP and PCT have low accuracy for cystitis, but might be useful for pyelonephritis.

scholarly journals Mortality of Diabetes-related Acute Metabolic Emergencies in COVID-19 patients: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Vasileios P. Papadopoulos ◽  
Peny Avramidou ◽  
Stefania-Aspasia Bakola ◽  
Dimitra-Geogia Zikoudi ◽  
Ntilara Touzlatzi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Diabetic Ketoacidosis ◽  
Critical Appraisal ◽  
Case Reports ◽  
Meta Analysis ◽  
Random Effects Model ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Meta Analyses

AbstractPurposeLittle is known on the mortality rate in COVID-19 related acute metabolic emergencies, namely diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS), combined DKA/HHS, and euglycaemic diabetic ketoacidosis (EDKA).MethodsA systematic literature review was conducted using EMBASE, PubMed/Medline, and Google Scholar from January 1, 2020 to January 9, 2021 to identify all case report series, cross-sectional studies, and meta-analyses of case reports describing mortality rate in DKA, HHS, and EDKA, in COVID-19 patients. The Joanna Briggs Institute critical appraisal checklist for case reports was used for quality assessment.ResultsFrom 313 identified publications, 4 fulfilled the inclusion criteria and analyzed qualitatively and quantitatively. A systematic review and meta-analysis with subgroup analyses examined mortality rate in a total of 152 COVID-19 patients who had developed DKA, HHS, combined DKA/HHS, or EDKA. Combined mortality rate and confidence intervals (CI) were estimated using random effects model. The study was registered to PROSPERO database (ID: 230737).ResultsCombined mortality rate was found to be 27.1% [95% CI: 11.2-46.9%]. Heterogeneity was considerable (I2=83%; 95% CI: 56-93%), corrected to 67% according to Von Hippel adjustment for small meta-analyses. Funnel plot presented no apparent asymmetry; Egger’s and Begg’s test yielded in P=0.44 and P=0.50, respectively. Sensitivity analysis failed to explain heterogeneity.ConclusionCOVID-19 related acute metabolic emergencies (DKA, HHS, and EDKA) are characterized by considerable mortality; thus, clinicians should be aware of timely detection and immediate treatment commencing.

scholarly journals A Systematic Review and Meta-Analysis of Serum Adiponectin Measurements in the Framework of Dog Obesity

Animals ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 1650
Author(s):  
Alberto Muñoz-Prieto ◽  
José Joaquín Cerón ◽  
Silvia Martínez-Subiela ◽  
Vladimir Mrljak ◽  
Asta Tvarijonaviciute
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Weight Loss ◽  
Biological Activities ◽  
Meta Analysis ◽  
Normal Weight ◽  
Hmw Adiponectin ◽  
Total Adiponectin ◽  
Successful Weight Loss ◽  
Meta Analyses

Adiponectin is an abundant plasma protein that is closely related to obesity and obesity-related pathologies. The molecule can be found in three different isoforms, each with different biological activities. Studies on canine obesity have suggested that adiponectin concentrations are decreased in obesity; however, no canine meta-analyses have been performed that feature all the required data. The aim of this study is to perform a systematic review and meta-analysis of studies that pertain to total and high molecular weight (HMW) adiponectin in relation to canine obesity. From 20 different studies, a total of 366 dogs with obesity and 349 normal weight dogs are included in the meta-analysis. Client-owned dogs were most represented, accounting for 54.3% of the dogs used, while experimental dogs enrolled in the studies made up the remaining 45.7%. The concentrations of total adiponectin in dogs with obesity were significantly lower compared with normal weight dogs. Additionally, adiponectin concentrations were significantly higher in dogs after a successful weight loss protocol compared to the start of the protocol and were significantly lower in dogs after gaining weight. In conclusion, although caution should be taken due to the relatively low number of studies that exist and the high heterogeneity between them, this meta-analysis indicates that adiponectin is decreased in obese dogs.

P60 CRITICAL APPRAISAL OF GASTRIC CONDUIT ISCHAEMIC CONDITIONING PRIOR TO OESOPHAGECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
K Kamarajah Sivesh ◽  
Boyle Charlie ◽  
R Bundred, James ◽  
HL Tan Benjamin
Keyword(s):  
Systematic Review ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Major Complication ◽  
Gastric Conduit ◽  
High Morbidity ◽  
Anastomotic Strictures ◽  
Meta Analyses ◽  
The Impact ◽  
Ischaemic Conditioning

Abstract Aim Anastomotic leaks remain a major complication following oesophagectomy, accounting for high morbidity and mortality. Recently, gastric ischaemic conditioning (GIC) has been proposed to improve anastomotic integrity through neovascularisation of the gastric conduit. This systematic review aims to determine the impact of GIC on postoperative outcomes after oesophagectomy. Background & Methods A systematic literature search was performed to identify studies reporting GIC for any indication of oesophageal resection. Random-effects meta-analyses were conducted for main outcomes. Results Nineteen studies were included reporting GIC, of which 13 were comparative studies. GIC were performed through ligation in 13 studies and embolisation in six studies. GIC did not appear reduce anastomotic leakages (OR 0.80, CI95: 0.51 - 1.24, p=0.3), anastomotic strictures (OR 0.75, CI95: 0.35 - 1.60, p=0.5), overall complications (OR 1.02, CI95: 0.48 - 2.16, p=0.9), major complications (OR 1.06, CI95: 0.53 - 2.11, p=0.9), or in-hospital mortality (OR 0.70, CI95: 0.32 - 1.53, p=0.4). However, preconditioning reduced the rates of conduit necrosis (OR 0.30, CI95: 0.11 - 0.77, p=0.013). Conclusion Gastric preconditioning through does not appear to reduce overall rates of anastomotic leakage after oesophagectomy but seems to reduce severity of leakages. More in depth studies are recommended.

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