Articles: sensitivity-specificity.
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Comparative Study
Validation and Comparison of Common Thoracolumbar Injury Classification Treatment Algorithms and a Novel Modification.
The most common thoracolumbar trauma classification systems are the Thoracolumbar Injury Classification and Severity Score (TLICS) and the Thoracolumbar AO Spine Injury Score (TL AOSIS). Predictive accuracy of treatment recommendations is a historical limitation. Our objective was to validate and compare TLICS, TL AOSIS, and a modified TLICS (mTLICS) that awards 2 points for the presence of fractured vertebral body height loss >50% and/or spinal canal stenosis >50% at the fracture site. ⋯ All systems performed well. The mTLICS had improved sensitivity and accuracy compared with TLICS and higher accuracy and specificity than TL AOSIS. The sensitivity of TL AOSIS was higher than that of TLICS. Prospective, multi-institutional reliability and validity studies of this mTLICS are needed for adoption.
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The clinical reasoning process for decision-making in medicine is complex and involves multiple factors, including diagnostic probabilities, study characteristics, costs, and patient preferences. This article highlights the role of pre-test probability in calculating the positive predictive value (PPV) and negative predictive value (NPV) of diagnostic tests and also likelihood ratios. ⋯ The notion of treatment and diagnostic thresholds is introduced, emphasizing their impact on medical decision-making. Finally, it underscores that diagnostic tests should only be requested if their results can change clinical management, promoting a rational and cost-effective approach to medical practice.
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MRI is crucial for multiple sclerosis (MS), but the relative value of portable ultra-low field MRI (pULF-MRI), a technology that holds promise for extending access to MRI, is unknown. We assessed white matter lesion (WML) detection on pULF-MRI compared to high-field MRI (HF-MRI), focusing on blinded assessments, assessor self-training, and multiplanar acquisitions. ⋯ With adequate training, radiological interpretation of pULF-MRI has high sensitivity and positive predictive value for MS lesions but should be approached conservatively. These results suggest utility for patient triage, potentially reducing diagnostic delay, and screening high-risk individuals.
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Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisDiagnostic test accuracy of self-administered cognitive assessment tools for dementia.
Dementia is a chronic and progressive clinical syndrome that can present with a range of cognitive and behavioural symptoms. Global prevalence is projected to increase due to ageing populations, particularly in resource-limited settings, with significant associated health and social care costs. There is a critical need for accurate cognitive assessment as part of the diagnostic workup for dementia. Although self-administered cognitive assessment tools are not diagnostic, they can be used to assess cognition. The role of these tests is uncertain, and their diagnostic test accuracy remains unclear, but they may be useful tools in circumstances where face-to-face assessment may be difficult. ⋯ There is insufficient evidence to recommend the use of any single self-administered cognitive assessment tool. The tools had test accuracy scores that are similar to the range seen with standard pencil and paper cognitive screening tests conducted by clinicians. Further research on the optimal test and threshold score, and how that may be impacted by setting, language, and educational level is needed.
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Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisThe effect of sample site and collection procedure on identification of SARS-CoV-2 infection.
Sample collection is a key driver of accuracy in the diagnosis of SARS-CoV-2 infection. Viral load may vary at different anatomical sampling sites and accuracy may be compromised by difficulties obtaining specimens and the expertise of the person taking the sample. It is important to optimise sampling accuracy within cost, safety and accessibility constraints. ⋯ When used with RT-PCR, there is no evidence for a difference in sensitivity of self-collected gargle or deep-throat saliva samples compared to nasopharyngeal samples collected by healthcare workers when used with RT-PCR. Use of these alternative, self-collected sample types has the potential to reduce cost and discomfort and improve the safety of sampling by reducing risk of transmission from aerosol spread which occurs as a result of coughing and gagging during the nasopharyngeal or oropharyngeal sample collection procedure. This may, in turn, improve access to and uptake of testing. Other types of saliva, nasal, oral and oropharyngeal samples are, on average, less sensitive compared to healthcare worker-collected nasopharyngeal samples, and it is unlikely that sensitivities of this magnitude would be acceptable for confirmation of SARS-CoV-2 infection with RT-PCR. When used with Ag-RDTs, there is no evidence of a difference in sensitivity between nasal samples and healthcare worker-collected nasopharyngeal samples for detecting SARS-CoV-2. The implications of this for self-testing are unclear as evaluations did not report whether nasal samples were self-collected or collected by healthcare workers. Further research is needed in asymptomatic individuals, children and in Ag-RDTs, and to investigate the effect of operator expertise on accuracy. Quality assessment of the evidence base underpinning these conclusions was restricted by poor reporting. There is a need for further high-quality studies, adhering to reporting standards for test accuracy studies.