2 búsqueda de la palabra clave 'Diagnostic accuracy'

Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: A systematic review and diagnostic test accuracy meta-analysis / Santiago León Atehortúa Muñoz    

Público ISBD Título : Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: A systematic review and diagnostic test accuracy meta-analysis Tipo de documento : documento electrónico Autores : Santiago León Atehortúa Muñoz, Fecha de publicación : 2022 Títulos uniformes : eClinicalMedicine Idioma : Inglés (eng) Palabras clave : CNS infection  Diagnostic accuracy  Encephalitis  Film array  Meningitis  Meta-analysis  Multiplex PCR Resumen : Background: The FilmArray Meningitis/Encephalitis(FA/ME) panel brings benefits in clinical practice, but its diagnostic test accuracy (DTA) remains unclear. We aimed to determine the DTA of FA/ME for the aetiological diagnostic in patients with suspected central nervous system(CNS) infection. Methods: We performed a systematic review with DTA meta-analysis (PROSPERO: CRD42020139285). We searched Embase, Medline (Ovid), and Web of Science from inception until September 1st, 2021. We assessed the study-level risk of bias with the QUADAS-2 tool and applied the GRADE approach to assess the certainty of the synthesised evidence. We included studies that simultaneously measured the reference test (CSF/blood culture for bacteria, and specific polymerase chain reaction for viruses) and the FA/ME in patients with suspected CNS infection. We performed random-effects bivariate meta-analysis models of combined sensitivity and specificity using CSF/blood cultures(reference test 1) and a final diagnosis adjudication based on clinical/laboratory criteria (reference test 2). Findings: We included 19 studies (11,351 participants). For all bacteria with reference test 1 (16 studies/6183 patients) sensitivity was estimated at 89·5% (95%CI 81·1-94·4), and specificity at 97·4% (95%CI 94-98·9). With reference test 2 (15 studies/5,524 patients), sensitivity was estimated at 92·1%(95%CI 86·8-95·3) and specificity at 99.2(95%CI 98·3-99·6) For herpes simplex virus-2(HSV-2), enteroviruses, and Varicella-Zoster virus (VZV), we obtained sensitivities between 75·5 and 93·8%, and specificities above 99% (reference test 1). Certainty of the evidence was low. Interpretation: FA/ME may have acceptable-to-high sensitivities and high specificities for identifying bacteria, especially for S.pneumoniae, and viruses, especially for HSV-2, and enteroviruses. Sensitivities for L.monocytogenes, H.influenzae, E.coli, and HSV-1 were suboptimal. Mención de responsabilidad : Juliana Trujillo-Gomez, Sofia Tsokani, Catalina Arango-Ferreira, Santiago Atehortua-Muñoz, Maria José Jimenez-Villegas, Carolina Serrano-Tabares, Areti-Angeliki Veroniki, and Ivan D. Florez Referencia : EClinicalMedicine. 2022 Feb 14;44:101275. DOI (Digital Object Identifier) : 10.1016/j.eclinm.2022.101275 PMID : 35198914 Derechos de uso : CC BY-NC-ND En línea : https://linkinghub.elsevier.com/retrieve/pii/S2589537022000050 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6011 Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: A systematic review and diagnostic test accuracy meta-analysis [documento electrónico] / Santiago León Atehortúa Muñoz,  . - 2022. Obra : eClinicalMedicine Idioma : Inglés (eng) Palabras clave : CNS infection  Diagnostic accuracy  Encephalitis  Film array  Meningitis  Meta-analysis  Multiplex PCR Resumen : Background: The FilmArray Meningitis/Encephalitis(FA/ME) panel brings benefits in clinical practice, but its diagnostic test accuracy (DTA) remains unclear. We aimed to determine the DTA of FA/ME for the aetiological diagnostic in patients with suspected central nervous system(CNS) infection. Methods: We performed a systematic review with DTA meta-analysis (PROSPERO: CRD42020139285). We searched Embase, Medline (Ovid), and Web of Science from inception until September 1st, 2021. We assessed the study-level risk of bias with the QUADAS-2 tool and applied the GRADE approach to assess the certainty of the synthesised evidence. We included studies that simultaneously measured the reference test (CSF/blood culture for bacteria, and specific polymerase chain reaction for viruses) and the FA/ME in patients with suspected CNS infection. We performed random-effects bivariate meta-analysis models of combined sensitivity and specificity using CSF/blood cultures(reference test 1) and a final diagnosis adjudication based on clinical/laboratory criteria (reference test 2). Findings: We included 19 studies (11,351 participants). For all bacteria with reference test 1 (16 studies/6183 patients) sensitivity was estimated at 89·5% (95%CI 81·1-94·4), and specificity at 97·4% (95%CI 94-98·9). With reference test 2 (15 studies/5,524 patients), sensitivity was estimated at 92·1%(95%CI 86·8-95·3) and specificity at 99.2(95%CI 98·3-99·6) For herpes simplex virus-2(HSV-2), enteroviruses, and Varicella-Zoster virus (VZV), we obtained sensitivities between 75·5 and 93·8%, and specificities above 99% (reference test 1). Certainty of the evidence was low. Interpretation: FA/ME may have acceptable-to-high sensitivities and high specificities for identifying bacteria, especially for S.pneumoniae, and viruses, especially for HSV-2, and enteroviruses. Sensitivities for L.monocytogenes, H.influenzae, E.coli, and HSV-1 were suboptimal. Mención de responsabilidad : Juliana Trujillo-Gomez, Sofia Tsokani, Catalina Arango-Ferreira, Santiago Atehortua-Muñoz, Maria José Jimenez-Villegas, Carolina Serrano-Tabares, Areti-Angeliki Veroniki, and Ivan D. Florez Referencia : EClinicalMedicine. 2022 Feb 14;44:101275. DOI (Digital Object Identifier) : 10.1016/j.eclinm.2022.101275 PMID : 35198914 Derechos de uso : CC BY-NC-ND En línea : https://linkinghub.elsevier.com/retrieve/pii/S2589537022000050 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6011

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Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study / Byron Enrique Piñeres Olave  

Público ISBD Título : Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study Tipo de documento : documento electrónico Autores : Byron Enrique Piñeres Olave, Fecha de publicación : 2020 Títulos uniformes : Intensive Care Medicine Idioma : Inglés (eng) Palabras clave : ARDS  Chest radiograph  Diagnostic accuracy  Inter-rater variability  Outcome Resumen : Purpose: Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the independent relationship between chest imaging and mortality and examine the inter-rater variability of interpretations of chest radiographs (CXR) in pediatric ARDS (PARDS). Methods: Prospective, international observational study in children meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria for PARDS, which requires new infiltrate(s) consistent with pulmonary parenchymal disease, without mandating bilateral infiltrates. Mortality analysis focused on the entire cohort, whereas inter-observer variability used a subset of patients with blinded, simultaneous interpretation of CXRs by intensivists and radiologists. Results: Bilateral infiltrates and four quadrants of alveolar consolidation were associated with mortality on a univariable basis, using CXRs from 708 patients with PARDS. For patients on either invasive (IMV) or non-invasive ventilation (NIV) with PaO2/FiO2 (PF) ratios (or SpO2/FiO2 (SF) ratio equivalent) > 100, neither bilateral infiltrates (OR 1.3 (95% CI 0.68, 2.5), p = 0.43), nor 4 quadrants of alveolar consolidation (OR 1.6 (0.85, 3), p = 0.14) were associated with mortality. For patients with PF ≤ 100, bilateral infiltrates (OR 3.6 (1.4, 9.4), p = 0.01) and four quadrants of consolidation (OR 2.0 (1.14, 3.5), p = 0.02) were associated with higher mortality. A subset of 702 CXRs from 233 patients had simultaneous interpretations. Interobserver agreement for bilateral infiltrates and quadrants was “slight” (kappa 0.31 and 0.33). Subgroup analysis showed agreement did not differ when stratified by PARDS severity but was slightly higher for children with chronic respiratory support (kappa 0.62), NIV at PARDS diagnosis (kappa 0.53), age > 10 years (kappa 0.43) and fluid balance > 40 ml/kg (kappa 0.48). Conclusion: Bilateral infiltrates and quadrants of alveolar consolidation are associated with mortality only for those with PF ratio ≤ 100, although there is high- inter-rater variability in these chest-x ray parameters. Mención de responsabilidad : Yolanda M López-Fernández, Lincoln S Smith, Joseph G Kohne, Jason P Weinman, Vicent Modesto-Alapont, Susana B Reyes-Dominguez, Alberto Medina, Byron E Piñeres-Olave, Natalie Mahieu, Margaret J Klein, Heidi R Flori, Philippe Jouvet, Robinder G Khemani, the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) V3 Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Referencia : Intensive Care Med. 2020 Jul;46(7):1382-1393. DOI (Digital Object Identifier) : 10.1007/s00134-020-06074-7 PMID : 32451578 En línea : https://link.springer.com/article/10.1007/s00134-020-06074-7 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5099 Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study [documento electrónico] / Byron Enrique Piñeres Olave,  . - 2020. Obra : Intensive Care Medicine Idioma : Inglés (eng) Palabras clave : ARDS  Chest radiograph  Diagnostic accuracy  Inter-rater variability  Outcome Resumen : Purpose: Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the independent relationship between chest imaging and mortality and examine the inter-rater variability of interpretations of chest radiographs (CXR) in pediatric ARDS (PARDS). Methods: Prospective, international observational study in children meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria for PARDS, which requires new infiltrate(s) consistent with pulmonary parenchymal disease, without mandating bilateral infiltrates. Mortality analysis focused on the entire cohort, whereas inter-observer variability used a subset of patients with blinded, simultaneous interpretation of CXRs by intensivists and radiologists. Results: Bilateral infiltrates and four quadrants of alveolar consolidation were associated with mortality on a univariable basis, using CXRs from 708 patients with PARDS. For patients on either invasive (IMV) or non-invasive ventilation (NIV) with PaO2/FiO2 (PF) ratios (or SpO2/FiO2 (SF) ratio equivalent) > 100, neither bilateral infiltrates (OR 1.3 (95% CI 0.68, 2.5), p = 0.43), nor 4 quadrants of alveolar consolidation (OR 1.6 (0.85, 3), p = 0.14) were associated with mortality. For patients with PF ≤ 100, bilateral infiltrates (OR 3.6 (1.4, 9.4), p = 0.01) and four quadrants of consolidation (OR 2.0 (1.14, 3.5), p = 0.02) were associated with higher mortality. A subset of 702 CXRs from 233 patients had simultaneous interpretations. Interobserver agreement for bilateral infiltrates and quadrants was “slight” (kappa 0.31 and 0.33). Subgroup analysis showed agreement did not differ when stratified by PARDS severity but was slightly higher for children with chronic respiratory support (kappa 0.62), NIV at PARDS diagnosis (kappa 0.53), age > 10 years (kappa 0.43) and fluid balance > 40 ml/kg (kappa 0.48). Conclusion: Bilateral infiltrates and quadrants of alveolar consolidation are associated with mortality only for those with PF ratio ≤ 100, although there is high- inter-rater variability in these chest-x ray parameters. Mención de responsabilidad : Yolanda M López-Fernández, Lincoln S Smith, Joseph G Kohne, Jason P Weinman, Vicent Modesto-Alapont, Susana B Reyes-Dominguez, Alberto Medina, Byron E Piñeres-Olave, Natalie Mahieu, Margaret J Klein, Heidi R Flori, Philippe Jouvet, Robinder G Khemani, the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) V3 Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Referencia : Intensive Care Med. 2020 Jul;46(7):1382-1393. DOI (Digital Object Identifier) : 10.1007/s00134-020-06074-7 PMID : 32451578 En línea : https://link.springer.com/article/10.1007/s00134-020-06074-7 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5099

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