Higher Proportion Of Positive Tests Research Articles

PARIS score for evaluation of probability of SARS-CoV-2 infection in cancer patients.

Control of transmissible diseases as COVID-19 needs a testing and an isolation strategy. The PARIS score developed by Torjdman et al. was aimed at improving patient selection for testing and quarantining but was derived from a general population. We performed a retrospective analysis of the validity of the PARIS score in a cancer patient population. We included 164 patients counting for 181 visits at the emergency department of the Jules Bordet Institute between March 10th and May 18th which had a SARS-CoV-2 RT-PCR test at admission. Twenty-six cases (14.3%) were tested positive with a higher proportion of positive tests among hematological patients compared to those with solid tumors (26% vs 11% p = 0.02). No clinical symptoms were associated with a positive SARS-CoV-2 PCR. No association between anticancer treatment and SARS-CoV-2 infection was found. The PARIS score failed to differentiate SARS-CoV-2-positive and SARS-CoV-2-negative groups (AUC 0.61 95% CI 0.48–0.73). The negative predictive value of a low probability PARIS score was 0.89 but this concerned only 11% of the patients. A high probability PARIS score concerned 49% patients but the positive predictive value was 0.18. CT scan had a sensitivity of 0.77, specificity 0.51, a positive predictive value of 0.24, and a negative predictive value of 0.92. The performance of the PARIS score is thus very poor in this cancer population. A low-risk score can be of some utility but this concerns a minority of patients.

Health surveillance of healthcare workers exposed to SARS-Cov-2 in Milan, Italy

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection recently became an issue of national relevance in Italy, especially in healthcare workers (HCWs) who have been exposed to the virus in times when preventive measures were not yet fully established. Methods: We collected occupational and clinical characteristics of all HCWs who had performed a nasopharyngeal swab for the detection of SARS-CoV-2 at the Policlinico Hospital in Milan, the capital city of Lombardy (the most affected Italian region), from February 24th to March 31st 2020. Laboratory data were collected as of April 9th. We compared frequencies of positive tests according to selected variables using chi-squared test and applied multivariable logistic regression models including gender, age class, occupation, and reported symptoms. Results: We found 138 test-positive HCWs out of a total of 1,573 (8.8%, 95% confidence interval [CI]: 7.4-10.3). Symptomatic subjects showed a much higher proportion of positive tests (20.2%, 95%CI: 16.7-24.1) when compared to asymptomatic ones (3.7%, 95%CI: 2.7-5.1, p<0.001). The strongest predictors of a positive test were fever (Odds ratio [OR] = 7.21, 95%CI: 4.45-11.7) and taste and smell alterations (OR = 29.7, 95%CI: 10.1-87.5). Fifty percent of subjects took up to 23 days (95%CI: 19-24) to become negative from first positive test. When considering occupation, the highest frequency of positive tests was detected among physicians (10.6%, 95%CI: 8.3-13.4). Conclusions: In a sample of HCWs exposed to confirmed cases of COVID-19, we found fever and taste and smell alterations to be strongly associated with SARS-CoV-2 infection, together with a median time to clear the virus of 23 days. The investigation in the Hospital is currently continuing by performing serological tests for identification of SARS-CoV-2 S1/S2 IgG antibodies including also the present study subjects. This will allow to assess the presence of specific antibodies to be compared with nasal swab tests.

Impact of the Introduction of High-Sensitive Troponin Assay in the Emergency Department: A Retrospective Study

BackgroundCompared with troponin T/I test, the introduction of a high-sensitive (hs) troponin test may result in a higher proportion of positive test results in patients with chest pain and over-testing in patients without acute coronary syndrome. We assessed the impact of the introduction of the hs-troponin assay on the discharge diagnoses and the number of diagnostic tests in patients presenting with chest pain in a real-life setting in an emergency department. MethodsRetrospective chart review of patients presenting with chest pain to one of the largest hospitals in Switzerland. We compared the standard troponin period (December 2009 to November 2010) with the hs-troponin period (December 2010 to December 2011). ResultsData from 1274 patients (standard 597 [46.9%], hs-troponin 677 [53.1%]) were analyzed. The proportion of patients with non-ST-segment elevation myocardial infarction increased (hs-troponin 14.9%, compared with 9.7%); the proportion in unstable angina (1.5% to 4.0%) and other cardiac illnesses (8.1% to 11.7%) decreased. Although the proportion of noncardiac chest pain illnesses (67%) remained unchanged, the proportion of positive hs-troponin was higher (6.1% vs 2.0%). The average number of additional tests/person decreased in troponin-positive patients (2.0 to 1.7 test per patient; P = .02) and troponin-negative patients (3.1 to 2.8 tests; P < .0001). ConclusionAlthough the introduction of the hs-troponin test resulted in a higher proportion of positive hs-troponin tests in patients with noncardiac chest pain, the average number of diagnostic tests decreased in patients with chest pain presenting to an emergency department, indicating an increased confidence of clinicians in their diagnosis.

Missing laboratory test data in electronic general practice records: analysis of rheumatoid factor recording in the clinical practice research datalink.

To investigate whether information from the literature could be used to identify periods of practice data in an electronic healthcare database during which rheumatoid factor (RF) test results are likely to be missing-not-at-random (MNAR). RF tests recorded in the Clinical Practice Research Datalink (CPRD) were identified and defined as having a positive, negative or missing result. The proportion of positive test results was then calculated based on (i) complete-case analysis (ii) after restriction to tests from practice years with no missing test results and (iii) following multiple imputation of missing test results. The same three analyses were then carried out after excluding practice years with a proportion of positive tests incompatible with the missing completely at random (MCAR) assumption. We identified 127,969 RF test records, 30.4% of which did not have an associated test result. Among tests with results available, 19% were positive. Both multiple imputation of the 38,867 missing test results and restriction of the study population to the 491 practice years with complete data had little impact on the percentage of positive tests. Following exclusion of the 544 practice years in which data were likely to be MNAR the percentage of positive tests in all analyses decreased to ~7%. Recording of RF tests and RF test results in the CPRD is incomplete, with data likely to be MNAR in many practices. Exclusion of practice years with a high proportion of positive tests brought the distribution of positive tests in the study in line with the literature.

Editorial: The less you look, the less you find

The article by Williams and colleagues2 shows a decreased incidence of ventriculitis when CSF samples are drawn from extraventricular drains (EVDs) less frequently. The authors compare a historical group of ICU patients to a prospective sample of ICU patients, in all of whom an EVD was placed for reasons not related to infections. In the historical group CSF samples were obtained daily, and in the prospective group samples were acquired every 3rd day. In the prospective group, there was a lower incidence of proven (CSF culture–positive) ventriculitis. This article describes a large experience and the study question is interesting. Even with no change in ventriculitis, reduced CSF sampling would reduce the cost of care in this group of patients. This is a welcome contribution to the literature. With the ever-escalating cost of care, we need more studies that evaluate reduced frequency interventions. In my biased opinion, I agree that we do not need daily CSF cultures drawn from EVDs, but I find limited support for my opinion in this paper for the following reasons: 1) There were more CSF cultures obtained per patient in the retrospective group. Each time we do a diagnostic test there is a risk of a false-positive result. In this situation, false positives may occur due to contamination of the specimen or detection of a clinically insignificant infection. It is therefore possible that the underlying incidence of ventriculitis is the same but the group that is tested more frequently has a higher proportion of positive tests. 2) In the prospective group, antibiotic-impregnated catheters were used. These may have contributed to a reduced infection rate or they may have resulted in falsenegative cultures in the prospective group.1 3) When the prospective data collection began, the “staff was provided with an education package on the purpose of the study and the changes in practice.” Everyone knew that a study was in progress, that the purpose was to see if ventriculitis would decrease, and that they were being watched. It has been well demonstrated that in such circumstances people “try harder.” I wonder, therefore, if the bedside nurses may have been more meticulous about CSF sample collection or wound care to avoid contamination. Although well intentioned, this could have altered the study results. 4) Formal reviews of every patient with an EVD were undertaken by the investigators in the prospective group. This kind of detailed scrutiny probably did not occur in the preintervention group and could have altered the detection of ventriculitis in a positive or negative direction. 5) The authors’ hypothesis is that accessing or opening the sterile EVD/CSF system might cause infection and that reduced sampling therefore might reduce infection. In light of that hypothesis, other occasions when the EVD/CSF system was accessed are relevant. Repeat EVD insertions or revisions might cause CSF contamination; there were more patients in the retrospective group who had multiple EVD insertions. In addition there were some patients with bilateral EVDs, but the frequency in the 2 groups was not described. Similarly, when EVDs malfunctioned, they were flushed with sterile saline and the frequency of flushing in the 2 groups was not provided. These events are opportunities for contamination of the CSF and could have altered the incidence of ventriculitis. 6) Extraventricular drains were implanted in the operating room or the ICU. Was the incidence of infection different between these 2 sites and if so were the groups balanced on location? Again, I am very happy to see assessments such as this, but I think there are a number of possible interpretations of the data: perhaps antibiotic-impregnated catheters work or result in false-negative cultures; perhaps 3rd-day sampling reduced contamination and caused the reduction in ventriculitis; or perhaps daily sampling was detecting organisms in the CSF that were contaminants or were asymptomatic and potentially resolved on their own. In other words, the more you look, the more you find, and the true underlying incidence may be completely unaffected by the sampling frequency. It may simply be that the authors detected fewer cases of “ventriculitis” because they looked less often.

S11.4 Serological screening for syphilis: research needs

Background and problemThe recent development and implementation of serological screening for syphilis using recombinant protein-based immunoassays has resulted in much confusion about the interpretation of positive results, particularly in low...

The Interrater Reliability of 4 Clinical Tests Used to Assess Individuals With Musculoskeletal Hip Pain

Descriptive and reliability study. To evaluate the interrater reliability of the FABER test, flexion-internal rotation-adduction impingement test, log roll test, and the palpation of the greater trochanter for tenderness. Clinical examination for individuals with musculoskeletal hip pain is believed to provide critical diagnostic information. However, there is very limited information in the literature on the reproducibility of examination techniques for the hip region. Seventy subjects were evaluated prospectively by an orthopaedic surgeon and physical therapist. Subjects had a mean age of 42 years (range 18-76 years; SD 15.4) and included 32 (46%) females and 38 (54%) males. Subject diagnoses were as follows: degenerative joint disease (n=27 [39% of subjects]), labral tear (n=35 [50% of subjects]), femoroacetabular impingement (n=48 [69% of subjects]), capsular laxity (n=28 [40% of subjects]), trochanteric bursitis (n=29 [41% of subjects]), iliopsoas tendonitis (n=10 [14% of subjects]), and adductor strain (n=2 [3% of subjects)]. Subjects could have more than 1 diagnosis. Kappa, prevalence indexes, bias indexes, and maximal attainable kappa were calculated. Kappa (kappa) coefficients with 95% confidence intervals (CI) were as follows: FABER test kappa was 0.63 (95% CI: 0.43-0.83); flexion-internal rotation-adduction impingement test kappa was 0.58 (95% CI: 0.29-0.87); log roll test kappa was 0.61 (95% CI: 0.41-0.81); and greater trochanteric tenderness kappa was 0.66 (95% CI: 0.48-0.84). Bias indexes were low (0.06-0.08) for all 4 tests while prevalence indexes were low (0.03-0.37) for 3 of the 4 tests. The flexion-internal rotation-adduction impingement test had a high prevalence index (0.76), with a higher proportion of positive tests. The kappa values for the FABER test, log roll test, and assessment of greater trochanteric tenderness were greater than 0.40 (fair level of agreement) at a 95% confidence level. The low reliability obtained for the flexion-internal rotation-adduction impingement test may be related to a prevalence concern.

An open clinical trial of naltrexone for amphetamine dependence: Compliance and tolerability

The aim of the study was to assess the feasibility of naltrexone as a potential pharmacotherapy for amphetamine dependence. The study design was an open-label clinical trial with 20 amphetamine-dependent patients receiving 12 weeks of treatment comprised of naltrexone (50 mg) along with relapse prevention therapy. Patients were assessed weekly for adverse events and compliance to medication. Tolerability to naltrexone was measured by patient's self-report and observed adverse effects along with plasma markers of hepatotoxicity. Compliance to treatment was measured by number of treatment days attended and by the presence of naltrexone's metabolite, 6-β-naltrexol in urine. Majority of the patients tolerated the medication well, also during relapse. Mild headache, nausea and abdominal pain were reported (n=3) but subsided within 2 weeks. Plasma levels of hepatic markers did not reveal any significant increase from baseline. Eleven out of 20 patients complied with the treatment and there was a significantly higher proportion of positive tests of 6-β-naltrexol in urine among patients completing 12 weeks of treatment compared to those who did not (77% vs. 22%). The frequency and amount of amphetamine consumed was significantly lower during treatment compared with pre-treatment consumption (P<0.01). In conclusion, naltrexone was well tolerated with moderate rates of compliance, supporting the feasibility of investigating this compound in a larger placebo-controlled trial as a potential pharmacotherapy for amphetamine dependence.

Screening females for Chlamydia trachomatis (CT) In a large managed care organization (Mco): A new hedis measure

Background: Since CT testing for females is a new Health Plan Employer Data and Information Set (HEDIS) measure to assess MCO quality of care, we determined the proportion of females enrolled in a large closed panel vertically integrated MCO serving a demographically diverse population who were tested for CT at least once during 1998 and resulting CT prevalences.Methods: A data base with MCO members ⩾ 12 yrs old tested with CT DNA probes (GenProbe) from 1/1/98–12/30/98 was examined. Only females 12–24 yrs old and enrolled at least 11 continuous months in 1998 were included in the analysis.Results: In 1998, 5425 (13.1%) of 41,566 females 12–24 yrs were CT tested and 849 (2.0%) tested positive at least once. Proportion of females tested and proportion of females testing positive at least once varied by age and clinic location. Among 11,562 12–14 yr females, 277 (2.4%) were CT tested and 48 (0.4%) tested positive; among 18,155 15–19 yr females, 2,424 (13.4%) were tested and 572 (3.2%) tested positive; and among 11,849 20–24 yr females, 2,724 (23.0%) were tested and 229 (1.9%) tested positive. The proportion 12–24 yr females tested was 579/3,945 (14.7%) with 92/3,945 (2.3%) testing positive in the Baltimore area; in Washington, DC/Maryland area 2,999/21,085 (14.2%) were tested with 601/21,085 (2.9%) testing positive; in Northern Virginia 1,847/16,536 (11.2%) were tested with 156/16,536 (0.9%) testing positive.Proportion of females with at least one positive test among those females who were tested for CT also varied by age and clinic location. Among 277 of 12–14 yr females tested 48 (17.3%) tested positive at least once; among 2,424 of 15–19 yr females tested, 572 (23.6%) tested positive at least once; and among 2,724 of 20–24 yr females tested, 229 (8.4%) tested positive at least once. The proportion of females tested with at least one positive test among 12–24 yr females was 92/579 (15.9%) in the Baltimore area, 601/2,999 (20.0%) in Washington DC/Maryland area, and 156/1,847 (8.4%) in Northern Virginia.Conclusion: CT testing of adolescent females 12–19 yrs revealed a high proportion of positive tests. The lower proportion of positive tests in young adults 20–24 yrs may be due to differences in prevalence and increased number of tests performed. CT testing practices and rates varied by location. Therefore, in a large MCO, a uniform system wide approach in identifying and screening sexually active adolescent females may identify a large reservoir or asymptomatic infection.