scholarly journals Frontline Screening for SARS-CoV-2 Infection at Emergency Department Admission by Third Generation Rapid Antigen Test: Can We Spare RT-qPCR?

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 818
Author(s):  
Valeria Cento ◽  
Silvia Renica ◽  
Elisa Matarazzo ◽  
Maria Antonello ◽  
Luna Colagrossi ◽  
...  
Keyword(s):  
Emergency Department ◽  
False Negative ◽  
Real Life ◽  
Digital Pcr ◽  
Diagnostic Tools ◽  
Third Generation ◽  
Emergency Department Admission ◽  
Active Viral Replication ◽  
Microfluidic Assays ◽  
Antigen Tests

To complement RT-qPCR testing for diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, many countries have introduced the use of rapid antigen tests. As they generally display lower real-life performances than expected, their correct positioning as frontline screening is still controversial. Despite the lack of data from daily clinical use, third generation microfluidic assays (such as the LumiraDx SARS-CoV-2 Ag test) have recently been suggested to have similar performances to RT-qPCR and have been proposed as alternative diagnostic tools. By analyzing 960 nasopharyngeal swabs from 960 subjects at the emergency department admissions of a tertiary COVID-19 hospital, LumiraDx assay demonstrated a specificity of 97% (95% CI: 96–98), and a sensitivity of 85% (95% CI: 82–89) in comparison with RT-qPCR, which increases to 91% (95% CI: 86–95) for samples with a cycle threshold ≤ 29. Fifty false-negative LumiraDx-results were confirmed by direct quantification of genomic SARS-CoV-2 RNA through droplet-digital PCR (median (IQR) load = 5880 (1657–41,440) copies/mL). Subgenomic N and E RNAs were detected in 52% (n = 26) and 56% (n = 28) of them, respectively, supporting the presence of active viral replication. Overall, the LumiraDx test complies with the minimum performance requirements of the WHO. Yet, the risk of a misrecognition of patients with active COVID-19 persists, and the need for confirmatory RT-qPCR should not be amended.

scholarly journals A Comparison of Emergency Department Admission Diagnoses and Discharge Diagnoses: Retrospective Study

2003 ◽  
Vol 10 (2) ◽  
pp. 70-75 ◽  
Author(s):  
HS Chiu ◽  
KF Chan ◽  
CH Chung ◽  
K Ma ◽  
KW Au
Keyword(s):  
Emergency Department ◽  
Young Adults ◽  
Retrospective Study ◽  
Diagnostic Accuracy ◽  
Diagnostic Tools ◽  
Admission Diagnosis ◽  
Discharge Diagnosis ◽  
Emergency Department Admission ◽  
Hospital Discharge Diagnosis ◽  
Male Sex

Objective To study the accuracy of emergency department admission diagnosis and the effect of investigations on diagnostic accuracy. Design Retrospective study in a two-month period. Setting Accident & Emergency Department of a public general hospital, which had four in-patient specialties – Medicine, Surgery, Paediatrics and Orthopaedics. Subjects All cases admitted through the emergency department in the study period. Main outcome measures Degree of correlation between emergency department admission diagnosis and hospital discharge diagnosis. Results Of all admission diagnoses, 71.4% fully or partially matched the final discharge diagnoses. The accuracy of diagnosis was statistically better in traumatic cases, the male sex and young adults. Diagnostic accuracy varied with the specialty involved and investigations taken. Conclusion History and physical examination remained the most important diagnostic tools in the emergency department. In general, simple investigations available at the emergency department were not helpful in improving diagnostic accuracy.

Emergency Department Admission and Mortality Rate for Suicidal Behavior

Crisis ◽  
2014 ◽  
Vol 35 (6) ◽  
pp. 406-414 ◽  
Author(s):  
Raimondo Maria Pavarin ◽  
Angelo Fioritti ◽  
Francesca Fontana ◽  
Silvia Marani ◽  
Alessandra Paparelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Metropolitan Area ◽  
Suicidal Behavior ◽  
Mortality Risk ◽  
Illicit Drugs ◽  
Attempted Suicide ◽  
Cox Model ◽  
Emergency Department Admission ◽  
Completed Suicide

Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.

Need for Confirmatory Neutralization Tests for Hepatitis B Surface Antigen Tests in Populations with Intermediate Prevalence

2021 ◽  
Author(s):  
Min Young Lee ◽  
So Young Kang ◽  
Woo In Lee ◽  
Myeong Hee Kim
Keyword(s):  
Hepatitis B ◽  
Surface Antigen ◽  
Neutralization Test ◽  
Hepatitis B Surface Antigen ◽  
False Negative ◽  
Confirmatory Test ◽  
Negative Group ◽  
Positive Group ◽  
Test Kit ◽  
Antigen Tests

Abstract Objective Hepatitis B surface antigen (HBsAg) is known as the hallmark of hepatitis B virus (HBV) infection. This study aimed to determine whether an HBsAg neutralization test is necessary to accurately interpret HBsAg test results. Methods Initially reactive HBsAg specimens from a 5-year period, with cutoff index values between 1.0 and 2.0, were subjected to neutralization confirmatory testing using an Elecsys HBsAg Confirmatory test kit (Roche Diagnostics GmbH. Mannheim, Germany). Results The neutralization test showed 46.1% positive (confirmed positive group) and 53.9% negative (confirmed negative group) results from the total specimens. Among the confirmed negative group, 79.5% of patients were confirmed to be negative for the current infection, whereas 4 patients in the chronic hepatitis B subgroup showed a neutralization percentage close to 40%. More than half of patients in the confirmed positive group were considered to be in the hepatitis B e antigen-negative inactive HBsAg carrier phase. Conclusion In populations with intermediate HBV prevalence, a neutralization test is necessary to confirm an HBsAg result and reduce the false positive and false negative rates of initial HBsAg tests.

scholarly journals CENTRAL NERVOUS SYSTEM INVOLVEMENT IN ADULT ACUTE LYMPHOBLASTIC LEUKEMIA: DIAGNOSTIC TOOLS, PROPHYLAXIS AND THERAPY

2014 ◽  
Vol 6 (1) ◽  
pp. e2014075 ◽  
Author(s):  
Maria Ilaria Del Principe ◽  
Luca Maurillo ◽  
Francesco Buccisano ◽  
Giuseppe Sconocchia ◽  
Mariagiovanna Cefalo ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Intrathecal Injection ◽  
False Negative ◽  
Diagnostic Tools ◽  
Positive Finding ◽  
Cns Involvement ◽  
Hematopoietic Stem

In adult patients with acute lymphoblastic leukemia (ALL), Central Nervous System (CNS) involvement is associated with a very poor prognosis. The diagnostic assessment of this condition relies on the use of neuroradiology, conventional cytology (CC) and flow cytometry (FCM). Among these approaches, which is the gold standard it is still a matter of debate. Neuroradiology and CC have a limited sensitivity with a higher rate of false negative results. FCM demonstrated a superior sensitivity over CC, particularly when low levels of CNS infiltrating cells are present. Although prospective studies of large series of patients are still awaited, a positive finding by FCM appears to anticipate an adverse outcome even if CC shows no infiltration. Current strategies for adult ALL CNS-directed prophylaxis or therapy involve systemic and intrathecal chemotherapy and radiation therapy. Actually, early and frequent intrathecal injection of cytostatic combined with systemic chemotherapy is the most effective strategy to reduce the frequency of CNS involvement. In patients with CNS overt ALL, at diagnosis or upon relapse, allogenic hematopoietic stem cell transplantation might be considered. This review will discuss risk factors, diagnostic techniques for identification of CNS infiltration and modalities of prophylaxis and therapy to manage it. 

Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity

Diagnosis ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 23-30 ◽  
Author(s):  
James Eames ◽  
Arie Eisenman ◽  
Richard J. Schuster
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Medical Center ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Admission Diagnosis ◽  
Mortality And Morbidity ◽  
Emergency Department Admission ◽  
Icu Length Of Stay ◽  
Discordant Group

AbstractPrevious studies have shown that changes in diagnoses from admission to discharge are associated with poorer outcomes. The aim of this study was to investigate how diagnostic discordance affects patient outcomes.: The first three digits of ICD-9-CM codes at admission and discharge were compared for concordance. The study involved 6281 patients admitted to the Western Galilee Medical Center, Naharyia, Israel from the emergency department (ED) between 01 November 2012 and 21 January 2013. Concordant and discordant diagnoses were compared in terms of, length of stay, number of transfers, intensive care unit (ICU) admission, readmission, and mortality.: Discordant diagnoses was associated with increases in patient mortality rate (5.1% vs. 1.5%; RR 3.35, 95% CI 2.43, 4.62; p<0.001), the number of ICU admissions (6.7% vs. 2.7%; RR 2.58, 95% CI 2.07, 3.32; p<0.001), hospital length of stay (3.8 vs. 2.5 days; difference 1.3 days, 95% CI 1.2, 1.4; p<0.001), ICU length of stay (5.2 vs. 3.8 days; difference 1.4 days, 95% CI 1.0, 1.9; p<0.001), and 30 days readmission (14.11% vs. 12.38%; RR 1.14, 95% CI 1.00, 1.30; p=0.0418). ED length of stay was also greater for the discordant group (3.0 vs. 2.9 h; difference 8.8 min; 95% CI 0.1, 0.2; p<0.001): These findings indicate discordant admission and discharge diagnoses are associated with increases in morbidity and mortality. Further research should identify modifiable causes of discordance.

scholarly journals Correction to: Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Cristian Giuseppe Monaco ◽  
Federico Zaottini ◽  
Simone Schiaffino ◽  
Alessandro Villa ◽  
Gianmarco Della Pepa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severity Score ◽  
X Ray ◽  
Emergency Department Admission ◽  
Centre Study ◽  
Chest X Ray

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals Prospective Validation of a Checklist to Predict Short‐term Death in Older Patients After Emergency Department Admission in Australia and Ireland

2018 ◽  
Vol 26 (6) ◽  
pp. 610-620 ◽  
Author(s):  
Magnolia Cardona ◽  
Michael O'Sullivan ◽  
Ebony T. Lewis ◽  
Robin M. Turner ◽  
Frances Garden ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Short Term ◽  
Emergency Department Admission

scholarly journals R-Score: A New Parameter to Assess the Quality of Variants’ Calls Assessed by NGS Using Liquid Biopsies

Biology ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 954
Author(s):  
Roberto Serna-Blasco ◽  
Estela Sánchez-Herrero ◽  
María Berrocal Renedo ◽  
Silvia Calabuig-Fariñas ◽  
Miguel Ángel Molina-Vila ◽  
...  
Keyword(s):  
Egfr Mutation ◽  
False Negative ◽  
Digital Pcr ◽  
Liquid Biopsies ◽  
Molecular Alterations ◽  
Significant Linear Correlation ◽  
Molecular Landscape ◽  
Nsclc Patients ◽  
Next Generation Sequencing Ngs

Next-generation sequencing (NGS) has enabled a deeper knowledge of the molecular landscape in non-small cell lung cancer (NSCLC), identifying a growing number of targetable molecular alterations in key genes. However, NGS profiling of liquid biopsies risk for false positive and false negative calls and parameters assessing the quality of NGS calls remains lacking. In this study, we have evaluated the positive percent agreement (PPA) between NGS and digital PCR calls when assessing EGFR mutation status using 85 plasma samples from 82 EGFR-positive NSCLC patients. According to our data, variant allele fraction (VAF) was significantly lower in discordant calls and the median of the absolute values of all pairwise differences (MAPD) was significantly higher in discordant calls (p < 0.001 in both cases). Based on these results, we propose a new parameter that integrates both variables, named R-score. Next, we sought to evaluate the PPA for EGFR mutation calls between two independent NGS platforms using a subset of 40 samples from the same cohort. Remarkably, there was a significant linear correlation between the PPA and the R-score (r = 0.97; p < 0.001). Specifically, the PPA of samples with an R-score ≤ −1.25 was 95.83%, whereas PPA falls to 81.63% in samples with R-score ≤ 0.25. In conclusion, R-score significantly correlates with PPA and can assist laboratory medicine specialists and data scientists to select reliable variants detected by NGS.

scholarly journals The immune checkpoints storm in COVID‐19: Role as severity markers at emergency department admission

2021 ◽  
Vol 11 (10) ◽  
Author(s):  
José Avendaño‐Ortiz ◽  
Roberto Lozano‐Rodríguez ◽  
Alejandro Martín‐Quirós ◽  
Verónica Terrón ◽  
Charbel Maroun‐Eid ◽  
...  
Keyword(s):  
Emergency Department ◽  
Immune Checkpoints ◽  
Emergency Department Admission
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