Articles: sensitivity-specificity.
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Reducing the number of unnecessary antibiotic prescriptions given for common respiratory infections has been recommended as a way to limit bacterial resistance. This study assessed the validity of a clinical sore throat score in 2 community emergency departments (EDs) and its impact on antibiotic prescribing. We also attempted to improve on this approach by using a rapid streptococcal antigen test. ⋯ An explicit clinical score approach to the management of GAS pharyngitis is valid in a community ED setting and could improve the pattern of antibiotic prescribing. While the addition of a rapid streptococcal antigen test significantly decreased the sensitivity of detecting GAS infections, a combined approach consisting of the clinical score and throat culture for patients with negative results on the rapid test would decrease antibiotic prescribing and telephone follow-up without decreasing the sensitivity of detecting GAS infection.
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Pediatr Crit Care Me · Apr 2002
Failed extubation after cardiac surgery in young children: Prevalence, pathogenesis, and risk factors.
A total of 212 children
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The purpose of this study is to evaluate both painless and painful sensory transmission in patients with Complex Regional Pain Syndrome (CRPS) using the automated electrodiagnostic sensory Nerve Conduction Threshold (sNCT) test. This test generates reliable, painless Current Perception Threshold (CPT) and atraumatic Pain Tolerance Threshold (PTT) measures. Standardized CPT and PTT measures using constant alternating current sinusoid waveform stimulus at 3 different frequencies 5 Hz, 250 Hz, and 2 kHz (Neurometer CPT/C Neurotron, Inc. ⋯ The correlation coefficient was lower for CPT than for PTT, ie, 0.34 versus 0.6 for the finger and 0.48 versus 0.67 for the toe, respectively. In studied CRPS patients an abnormal PTT was detected with higher sensitivity than an abnormal CPT. Assessing PTT may become a useful electrodiagnostic quantitative sensory test for diagnosing and following the course of neuropathic pain conditions.
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Pediatr Crit Care Me · Jul 2000
Comparison of predictors of extubation from mechanical ventilation in children.
Unsuccessful extubation from mechanical ventilation increases mortality and morbidity. Therefore, the identification of an accurate predictor of successful extubation is desirable. This study was designed to determine whether the results of easily performed respiratory measurements, particularly if reported as "combined extubation" indices, were better predictors of extubation failure in a pediatric population than were readily available clinical data. DESIGN: Prospective observational study. SETTING: Tertiary pediatric intensive care unit. PATIENTS: All children who required mechanical ventilation for >/=24 hrs during a 12-month period and whose parents gave informed written consent. INTERVENTIONS: Respiratory function measurements were made (on average) 7 hrs (range, 0.2-25.0 hrs) before extubation. Arterial blood gas results were obtained immediately before extubation. The values of each predictor associated with maximum sensitivity and specificity were determined, and the areas under receiver operator characteristic curves were compared to determine the most accurate predictor of successful extubation. MEASUREMENTS AND MAIN ⋯ Volume measurements during pediatric mechanical ventilation may facilitate successful extubation.
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Patients with suspected opioid overdose frequently require naloxone treatment. Despite recommendations to observe such patients for 4 to 24 hours after naloxone, earlier discharge is becoming more common. This prospective, observational study of patients with presumed opioid overdose examines the safety of early disposition decisions and the accuracy of outcome prediction by physicians 1 hour after the administration of naloxone. ⋯ Emergency physicians can clinically identify patients at risk of deterioration after naloxone reversal of suspected opioid overdose. Prolonged observation or hospital admission is not usually required. Selective early discharge of patients with presumed opioid overdose is feasible and appears safe. A clinical prediction rule may be useful in identifying patients eligible for early discharge.