Articles: sensitivity-specificity.
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Spinal injuries occur in 3% of all patients with trauma, most commonly in males, and often as a result of high-velocity impact followed by abrupt deceleration. The most affected region after spinal trauma is the thoracolumbar junction because of the anterior center of gravity at the T12-L1 vertebral level and the relatively stiff thoracic spine uniting with the mobile lumbar spine. Many classifications exist to guide the choice of operative versus nonoperative management of traumatic injuries at this site. ⋯ Ignoring this aspect of thoracolumbar management often contributes to the development of posttraumatic malalignment and other complications. This review recommends that a new or modified classification system accounts for sagittal segmental alignment factors, including the level of the injured vertebra, the number of affected adjacent levels, imaging techniques with better specificity and sensitivity, and assessment for osteoporosis. Case studies are included to show the importance of segmental sagittal alignment and the vertebral level on patient outcomes.
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Cochrane Db Syst Rev · Oct 2024
Review Meta AnalysisArtificial intelligence for diagnosing exudative age-related macular degeneration.
Age-related macular degeneration (AMD) is a retinal disorder characterized by central retinal (macular) damage. Approximately 10% to 20% of non-exudative AMD cases progress to the exudative form, which may result in rapid deterioration of central vision. Individuals with exudative AMD (eAMD) need prompt consultation with retinal specialists to minimize the risk and extent of vision loss. Traditional methods of diagnosing ophthalmic disease rely on clinical evaluation and multiple imaging techniques, which can be resource-consuming. Tests leveraging artificial intelligence (AI) hold the promise of automatically identifying and categorizing pathological features, enabling the timely diagnosis and treatment of eAMD. ⋯ Low- to very low-certainty evidence suggests that an algorithm-based test may correctly identify most individuals with eAMD without increasing unnecessary referrals (false positives) in either the primary or the specialty care settings. There were significant concerns for applying the review findings due to variations in the eAMD prevalence in the included studies. In addition, among the included algorithm-based tests, diagnostic accuracy estimates were at risk of bias due to study participants not reflecting real-world characteristics, inadequate model validation, and the likelihood of selective results reporting. Limited quality and quantity of externally validated algorithms highlighted the need for high-certainty evidence. This evidence will require a standardized definition for eAMD on different imaging modalities and external validation of the algorithm to assess generalizability.
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Cochrane Db Syst Rev · Oct 2024
Review Meta AnalysisLaboratory-based molecular test alternatives to RT-PCR for the diagnosis of SARS-CoV-2 infection.
Diagnosing people with a SARS-CoV-2 infection played a critical role in managing the COVID-19 pandemic and remains a priority for the transition to long-term management of COVID-19. Initial shortages of extraction and reverse transcription polymerase chain reaction (RT-PCR) reagents impaired the desired upscaling of testing in many countries, which led to the search for alternatives to RNA extraction/purification and RT-PCR testing. Reference standard methods for diagnosing the presence of SARS-CoV-2 infection rely primarily on real-time reverse transcription-polymerase chain reaction (RT-PCR). Alternatives to RT-PCR could, if sufficiently accurate, have a positive impact by expanding the range of diagnostic tools available for the timely identification of people infected by SARS-CoV-2, access to testing and the use of resources. ⋯ Alternative laboratory-based molecular tests aim to enhance testing capacity in different ways, such as reducing the time, steps and resources needed to obtain valid results. Several index test technologies with these potential advantages have not been evaluated or have been assessed by only a few studies of limited methodological quality, so the performance of these kits was undetermined. Only two index test categories with enough evaluations for meta-analysis fulfil the WHO set of acceptable accuracy standards for SARS-CoV-2 nucleic acid tests: RT-PCR assays designed to omit/adapt RNA extraction/purification and TMA assays. These assays might prove to be suitable alternatives to RT-PCR for identifying people infected by SARS-CoV-2, especially when the alternative would be not having access to testing. However, these findings need to be interpreted and used with caution because of several limitations in the evidence, including reliance on retrospective samples without information about the symptom status of participants and the timing of assessment. No extrapolation of found accuracy data for these two alternatives to any test brands using the same techniques can be made as, for both groups, one test brand with high accuracy was overrepresented with 21/26 and 12/14 included studies, respectively. Although we used a comprehensive search and had broad eligibility criteria to include a wide range of tests that could be alternatives to RT-PCR methods, further research is needed to assess the performance of alternative COVID-19 tests and their role in pandemic management.
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Meta Analysis
Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes: Systematic Review and Meta-Analysis.
Acute aortic syndrome is a life-threatening emergency condition. Previous systematic reviews of D-dimer diagnostic accuracy for acute aortic syndrome have been contradictory and based on limited data, but recently published studies offer potential for a more definitive overview. We aimed to perform a systematic review and meta-analysis to determine the diagnostic accuracy of D-dimer for diagnosing acute aortic syndrome. ⋯ D-dimer concentration has high sensitivity (96.5%) and moderate specificity (56.2%) for acute aortic syndrome, with some uncertainty around estimates due to risk of bias and heterogeneity. Previous meta-analysis reporting higher specificity may be explained by inclusion of case-control studies that may overestimate accuracy.
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Multiple decision-aiding models are available to help physicians identify acute coronary syndrome (ACS) and accelerate the decision-making process in emergency departments (EDs). This study evaluated the diagnostic performance of the Manchester Acute Coronary Syndrome (MACS) rule and its derivations, enhancing the evidence for their clinical use. A systematic review and meta-analysis was performed. ⋯ Of all the MACS models, T-MACS displayed the highest overall accuracy due to its high sensitivity and significantly superior specificity. T-MACS exhibits very good diagnostic performance in predicting both AMI and MACE. This makes it a highly promising tool for managing patients with acute chest pain.