Diagnostic accuracy of HLA-B*57:01 screening for the prediction of abacavir hypersensitivity and clinical utility of the test: a meta-analytic review

2014 ◽  
Vol 15 (7) ◽  
pp. 963-976 ◽  
Author(s):  
Sarah Cargnin ◽  
Claudio Jommi ◽  
Pier Luigi Canonico ◽  
Armando A Genazzani ◽  
Salvatore Terrazzino
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Utility ◽  
Analytic Review

Translation: Beyond Diagnostic Accuracy: The Clinical Utility of Diagnostic Tests

2013 ◽  
Vol 3 (4) ◽  
pp. 269
Author(s):  
Patrick M.M. Bossuyt ◽  
Johannes B. Reitsma ◽  
Kristian Linnet ◽  
Karel G.M. Moons
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tests ◽  
Clinical Utility

scholarly journals Diagnostic accuracy and clinical utility of a simplified low cost method of counting CD4 cells with flow cytometry in Malawi: diagnostic accuracy study

BMJ ◽  
2007 ◽  
Vol 335 (7612) ◽  
pp. 190-190 ◽  
Author(s):  
Calman A MacLennan ◽  
Michael K P Liu ◽  
Sarah A White ◽  
Joep J G van Oosterhout ◽  
Felanji Simukonda ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Diagnostic Accuracy ◽  
Clinical Utility ◽  
Low Cost ◽  
Diagnostic Accuracy Study ◽  
Cd4 Cells ◽  
Accuracy Study

Clinical Utility of Striational Antibodies in Paraneoplastic and Myasthenia Gravis Paraneoplastic Panels

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012050
Author(s):  
Shahar Shelly ◽  
John R Mills ◽  
Divyansu Dubey ◽  
Andrew McKeon ◽  
Anastasia Zekeridou ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Myasthenia Gravis ◽  
Clinical Utility ◽  
Roc Analysis ◽  
Thymic Cancer ◽  
Diagnostic Characteristics ◽  
Data Platform ◽  
Neurological Phenotype ◽  
Antibody Positivity

Objective:To critically assess the clinical utility of striational antibodies (StrAbs) within paraneoplastic and myasthenia gravis serological evaluations.Methods:All Mayo Clinic patients tested for StrAbs from January 1st 2012-December 31st 2018 utilizing Mayo’s Unified Data Platform (UDP) were reviewed for neurological diagnosis and cancer.Results:38,502 unique paraneoplastic and 1,899 MG patients were tested. In paraneoplastic evaluations, the StrAbs positivity rate was higher in cancer vs without cancer (5% [321/6775] vs 4% [1154/31727]; p<0.0001; OR 1.35; CI=1.19-1.53) but ROC analysis indicated no diagnostic accuracy in cancer (AUC=0.505). No neurological phenotype was significantly associated with StrAbs in the paraneoplastic group. Positivity was more common in all MG cancers compared to paraneoplastic cancers (p<0.0001). In MG evaluations, the StrAbs positivity rate was higher in those with cancer vs without (46% [217/474] vs 26% [372/1425]; p<0.0001; OR 2.39, CI 1.9-2.96) with ROC analysis indicating poor diagnostic accuracy for thymic cancer (AUC 0.634, recommended cutoff=1:60, sensitivity=56%, specificity=71%), with worse accuracy for extrathymic cancers (AUC 0.543). In paraneoplastic or MG evaluations, the value of antibody positivity did not improve cancer predictions. Paraneoplastic evaluated patients were more likely with positive StrAbs to obtain computed tomography (CT) (p=0.0001) with 3% (12/468) cancer found.Conclusion:Despite a statistically significant association with cancer, an expansive review of performance in clinical service demonstrates that StrAbs are neither specific nor sensitive in predicting malignancy or neurological phenotypes. CT imaging is over utilized with positive StrAbs results. Removal of StrAbs from paraneoplastic or MG evaluations will improve the diagnostic characteristics of the current MG test.Classification of Evidence:This study provides Class II evidence that the presence of StrAbs do not accurately identify patients with malignancy or neurological phenotypes.

scholarly journals Detecting delirium superimposed on dementia: diagnostic accuracy of a simple combined arousal and attention testing procedure

2017 ◽  
Vol 29 (10) ◽  
pp. 1585-1593 ◽  
Author(s):  
Sarah J. Richardson ◽  
Daniel H. J. Davis ◽  
Giuseppe Bellelli ◽  
Wolfgang Hasemann ◽  
David Meagher ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Medical Records ◽  
Clinical Utility ◽  
The Elderly ◽  
Testing Procedure ◽  
Cognitive Tests ◽  
Attention Task ◽  
High Diagnostic Accuracy ◽  
Eye Opening ◽  
Delirium Superimposed On Dementia

ABSTRACTBackground:Detecting delirium superimposed on dementia (DSD) can be challenging because assessment partly relies on cognitive tests that may be abnormal in both conditions. We hypothesized that a combined arousal and attention testing procedure would accurately detect DSD.Methods:Patients aged ≥70 years were recruited from five hospitals across Europe. Delirium was diagnosed by physicians using DSM-5 criteria using information from nurses, carers, and medical records. Dementia was ascertained by the Informant Questionnaire on Cognitive Decline in the Elderly. Arousal was measured using the Observational Scale of Level of Arousal (OSLA), which assesses eye opening, eye contact, posture, movement, and communication. Attention was measured by participants signaling each time an “A” was heard when “S-A-V-E-A-H-A-A-R-T” was read out.Results:The sample included 114 persons (mean age 82 years (SD 7); 54% women). Dementia alone was present in 25% (n = 28), delirium alone in 18% (n = 21), DSD in 27% (n = 31), and neither in 30% (n = 34). Arousal and attention was assessed in n = 109 (96%). Using OSLA, 83% participants were correctly identified as having delirium (sensitivity 85%, specificity 82%, AUROC 0.92). The attention task correctly classified 76% of participants with delirium (sensitivity 90%, specificity 64%, AUROC 0.80). Combining scores correctly classified 91% of participants with delirium (sensitivity 84%, specificity 92%, AUROC 0.94). Diagnostic accuracy remained high in the subgroup with dementia (93% correctly classified, sensitivity 94%, specificity 92%, AUROC 0.98).Conclusions:This combined arousal–attention assessment to detect DSD was brief yet had high diagnostic accuracy. Such an approach could have clinical utility for diagnosing DSD.

scholarly journals Examination of Regression-based Discrepancy Scores for the RBANS in Detecting Cognitive Impairment from an Archival Sample

2018 ◽  
Vol 34 (8) ◽  
pp. 1329-1339 ◽  
Author(s):  
William F Goette ◽  
Andrew L Schmitt
Keyword(s):  
Cognitive Impairment ◽  
Diagnostic Accuracy ◽  
Clinical Utility ◽  
Word Reading ◽  
Neuropsychological Test ◽  
Clinical Neuropsychology ◽  
Standard Score ◽  
Neuropsychological Status ◽  
Total Scale Score ◽  
Performance Results

Abstract Objective The purpose of this study was to evaluate the clinical utility of regression-based formulas for the RBANS indexes in screening for cognitive impairment. Method A database of neuropsychological test results was created from archival records in a memory assessment clinic. The sample consisted of 83 individuals (37 males/46 females) with an average age of 70.1 (SD = 9.8) and 14.6 years of education (SD = 2.8). Diagnostic accuracy of regression-based predictions provided by Duff and Ramezani (2015) (Duff, K., & Ramezani, A. (2015). Regression-based normative formulae for the Repeatable Battery for the Assessment of Neuropsychological Status for older adults. Archives of Clinical Neuropsychology, 30, 600–604.) and from regression of WTAR standard score were examined via receiver operator characteristic curves. Preliminary generalizability investigation was completed using two additional datasets. Results The WTAR was found to mediate the relationship between education and all RBANS index scores. The WTAR standard score was also found to contribute uniquely and significantly to the prediction of RBANS performance. Results of diagnostic accuracy analyses showed similar discriminating accuracy for all scores. There was limited support for using the WTAR over demographic variables alone in the estimation of RBANS performance; however, the WTAR was found to be more predictive than education, indicating potential clinical utility to using the word-reading score over just years of attained education. Conclusions Use of these derived Total Scale score variants is recommended for the screening of cognitive impairment, particularly in individuals with superior or poor educational quality. Further research is required to evaluate the utility of these variations in more diverse samples.

scholarly journals Beyond Diagnostic Accuracy: The Clinical Utility of Diagnostic Tests

2012 ◽  
Vol 58 (12) ◽  
pp. 1636-1643 ◽  
Author(s):  
Patrick MM Bossuyt ◽  
Johannes B Reitsma ◽  
Kristian Linnet ◽  
Karel GM Moons
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tests ◽  
Clinical Utility ◽  
Randomized Clinical Trials ◽  
Diagnostic Testing ◽  
Daily Practice ◽  
Technical Performance ◽  
Management Actions ◽  
Negative Results ◽  
Definition Of

Abstract Like any other medical technology or intervention, diagnostic tests should be thoroughly evaluated before their introduction into daily practice. Increasingly, decision makers, physicians, and other users of diagnostic tests request more than simple measures of a test's analytical or technical performance and diagnostic accuracy; they would also like to see testing lead to health benefits. In this last article of our series, we introduce the notion of clinical utility, which expresses—preferably in a quantitative form—to what extent diagnostic testing improves health outcomes relative to the current best alternative, which could be some other form of testing or no testing at all. In most cases, diagnostic tests improve patient outcomes by providing information that can be used to identify patients who will benefit from helpful downstream management actions, such as effective treatment in individuals with positive test results and no treatment for those with negative results. We describe how comparative randomized clinical trials can be used to estimate clinical utility. We contrast the definition of clinical utility with that of the personal utility of tests and markers. We show how diagnostic accuracy can be linked to clinical utility through an appropriate definition of the target condition in diagnostic-accuracy studies.

scholarly journals The Clinical Utility of the Heparin Neutralization Assay in the Diagnosis of Heparin-Induced Thrombocytopenia

2017 ◽  
Vol 24 (5) ◽  
pp. 749-754 ◽  
Author(s):  
Gang Zheng ◽  
Michael B. Streiff ◽  
Clifford M. Takemoto ◽  
Jennifer Bynum ◽  
Elise Gelwan ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Clinical Utility ◽  
Predictive Accuracy ◽  
High Sensitivity ◽  
Neutralization Assay ◽  
Serotonin Release ◽  
Enzyme Linked Immunosorbent Assay ◽  
Heparin Induced Thrombocytopenia ◽  
Heparin Neutralization

Heparin-induced thrombocytopenia (HIT) remains diagnostically challenging. Immunoassays including PF4/heparin enzyme-linked immunosorbent assay (ELISA) have high sensitivity but low specificity. Whether the heparin neutralization assay (HNA) improves the diagnostic accuracy of the PF4/heparin ELISA for HIT is uncertain. In this study, to assess its clinical utility and evaluate whether it improves the diagnostic accuracy for HIT, we implemented HNA in conjunction with PF4/heparin ELISA over a 1-year period. A total of 1194 patient samples were submitted to the laboratory for testing from December 2015 to November 2016. Heparin neutralization assay alone is a poor predictor for HIT, but it has high negative predictive value (NPV): Cases with %inhibition <70% are always negative for serotonin release assay. It improves the diagnostic positive predictive value (PPV) of ELISA without compromising sensitivity: ELISA optical density (OD) ≥1.4 alone has a sensitivity of 88% (14/16) and a PPV of 61% (14/23); with HNA %inhibition ≥70%, the sensitivity remains 88% (14/16) and PPV is 82% (14/17). 4Ts score correlates with ELISA OD and predicts HIT; the predictive accuracy of 4Ts score is further improved by HNA. Interestingly, HNA %inhibition of <70% correlates with low 4Ts scores. Based on its high NPV, HNA has the potential to facilitate more timely and accurate HIT diagnosis.

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