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Introduction: Numerous studies have demonstrated the accuracy of point-of-care ultrasound (POCUS). Portable, handheld devices have expanded the clinical scope of POCUS at a fraction of the cost of traditional, cart-based models. There is a paucity of data assessing the diagnostic accuracy of portable devices. Our objective in this study was to compare the diagnostic accuracy of a portable device with a cart-based model.Methods: This was an institutional review board-approved, observational, prospective, randomized clinical trial (NCT05196776) of a convenience sample of adult patients who presented to a university-based health system. Patients who required a cardiac, lung, renal, aorta, or biliary POCUS were randomized to a portable device or to a cart-based model. We hypothesized that the cart-based model would have a 90% diagnostic accuracy vs 70% for the handheld device. To detect a 20% difference, the sample size was calculated to be 98, with 49 patients randomized to each arm. We used standard 2x2 tables to calculate test characteristics with 95% confidence intervals (CI).Results: A total of 110 patients were enrolled, with 56 patients randomized to the cart-based model and 54 to the handheld device. The sensitivity, specificity, and diagnostic accuracy of the cart-based vs handheld were 77.8% (40–97.2) vs 92.9% (66.1–99.8), 91.5% (79.6–97.6) vs 92.3% (79.1–98.4%), and 89.3% (78.1–96) vs 92.5% (81.8–97.9), respectively.Conclusion: The diagnostic accuracy of a portable, handheld device is similar to that of a cart-based model.

Background Methods Results Conclusions Ancillary immunohistochemistry testing for p16 loss has been proposed as a diagnostic tool for melanoma, but its accuracy remains uncertain.A systematic review and meta‐analysis were conducted on 26 studies involving 979 melanomas and 974 nevi.Through bivariate analysis of data across all cut‐off values, the sensitivity and specificity were calculated to be 0.55 (95% confidence interval [CI]: 0.38, 0.70) and 0.85 (95% CI: 0.70, 0.94), respectively. Summary estimates of diagnostic accuracy fell below recommended thresholds for effective tests, but subgroup analysis suggested that p16 loss could aid in diagnosing ambiguous lesions as melanoma in certain scenarios. However, the presence of p16 expression in these contexts does not definitively rule out melanoma. The findings were limited by underpowered exploratory study designs at risk for bias in patient selection and test interpretation.While the use of p16 immunohistochemistry for detecting melanoma is not universally reliable, it may serve as a confirmatory test in differential diagnoses involving common, congenital, acral, Spitz, and deep penetrating nevi. Nevertheless, further studies are needed to validate its utility. Until then, the application of p16 immunohistochemistry in melanoma diagnosis should be regarded as experimental. [ABSTRACT FROM AUTHOR]

Existing challenges with the early diagnosis of rheumatoid arthritis (RA) and active disease, mainly by non-rheumatologists, have prompted the search for novel biomarkers. Elevations in indices derived from blood cell counts, e.g., the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), have been reported in RA patients. However, their diagnostic accuracy has not been comprehensively assessed. Therefore, we conducted a systematic review and meta-analysis of studies reporting the sensitivity and specificity of the NLR and PLR, obtained by receiver operating characteristic (ROC) curve analysis, for the presence of RA and active disease. We searched electronic databases from inception to 15 March 2024 and assessed the risk of bias using the JBI Critical Appraisal Checklist (PROSPERO registration number: CRD42024533546). In 15 studies, the NLR exhibited acceptable accuracy for the presence of RA (area under the curve, AUC = 0.76, 95% CI 0.72 to 0.80) and active disease (AUC = 0.70, 95% CI 0.66 to 0.74). The PLR exhibited good accuracy for the presence of RA (AUC = 0.80, 95% CI 0.76 to 0.83). There were insufficient studies to assess the accuracy of the PLR for the presence of active disease. Our systematic review and meta-analysis suggests that the NLR and the PLR are promising biomarkers of RA (NLR and PLR) and active disease (NLR). Further research is required to investigate whether the NLR and PLR can significantly enhance the capacity to diagnose RA and active disease in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The current study relates to the utility of the levels of B-type natriuretic peptide (BNP) as a biomarker in the management and diagnostic evaluation of heart failure in various patient populations. Methods: A comparison of BNP levels between patients with different types of heart diseases was conducted using ROC curve analysis to assess how well BNP could predict the degree of heart failure. Results: The results established an important correlation between increased BNP, with risk of elevated BNP levels, and increased severity of the heart failure, proposing effectiveness of the peptide in the risk stratification and clinical decision-making. Conclusion: Our findings confirm the necessity of BNP level testing implementation in practical clinical activity to provide enhanced options for shortening the diagnosis time and further treatment beginning among the heart failure patient population in order to improve their prognosis. The research in the future is assessing the potential of BNP in terms of this prediction in relation to different population demographics and, therefore, conducting a modification in terms of broader clinical applications. This study's findings add to strong and growing evidence-based support for BNP as a functional biomarker in cardiovascular health. [ABSTRACT FROM AUTHOR]

Background Pancreatic cancer (PC) is usually detected in the advanced stages. Liquid biopsy has become a revolutionary strategy for cancer diagnosis and prognosis prediction. This study aims to investigate the diagnostic and prognostic value of circulating exosomal glypican-1 (GPC-1) in PC. Methods We systematically searched relevant studies. For diagnostic accuracy, pooled sensitivity and specificity and the area under the summary receiver operating characteristic curve (AUC) were calculated. Regarding prognostic value, hazard ratios (HRs) and 95% CIs for overall survival (OS) were summarized by using a random-effects model. Results We found 8 studies that examined the diagnostic value of circulating exosomal GPC-1 in PC, and 3 studies that investigated its prognostic value. Pooled sensitivity and specificity were 0.88 (95% CI, 0.65-0.97) and 0.86 (95% CI, 0.72-0.94). The AUC was 0.93 (95% CI, 0.90-0.95). Prognostic analysis showed that higher levels of circulating exosomal GPC-1 were associated with poorer OS in PC patients, and the combined HR for OS was 4.59 (random-effects model, 95% CI = 1.17-18.03, P =.022). The results of both studies were robust and neither had publication bias. Conclusion Circulating exosomal GPC-1 may be used as a diagnostic and prognostic biomarker for PC. However, this result needs to be validated by further research using a larger sample size. [ABSTRACT FROM AUTHOR]

Background: Pauci‐immune glomerulonephritis (GN) due to antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis (AAV) is a common cause of crescentic GN. Despite advances in treatment, rates of mortality and progression to end‐stage kidney disease remain high. Renal involvement is diagnosed by histological examination of kidney tissue. Serum ANCAs play a significant role in AAV; however, the value of serum ANCA quantification to predict renal involvement is not well‐established. Aim: We aimed to evaluate the diagnostic accuracy of serum ANCA titres in diagnosing AAV with renal involvement. Methods: We conducted a retrospective study of consecutive native kidney biopsies reported at our centre from 2016 to 2021. We included all adults who had both a kidney biopsy and ANCA serology. ANCA serology was tested using indirect immunofluorescence with reporting of titres. Antibodies to proteinase 3 and myeloperoxidase were measured using a chemiluminescent immunoassay. Results: Eight hundred and forty‐eight native kidney biopsies were reported during the study period. Five hundred and seven cases were included. The biopsy prevalence of pauci‐immune GN in paired samples was 41/507 (8.1%). Most of the cohort had haematuria (66.6%), proteinuria (93.4%) and/or acute kidney injury (65.0%). A positive ANCA at any titre demonstrated a sensitivity of 97.6% and a specificity of 71.2% for a diagnosis of pauci‐immune GN. The area under the curve for the receiver operator characteristic was 0.93 (95% confidence interval [CI]: 0.89–0.97). A cutoff ANCA titre of 1:160 provided the optimum balance between a sensitivity of 75.6% (95% CI: 59.7%–87.6%) and a specificity of 94.0% (95% CI: 91.6%–96.0%). Conclusions: ANCA titres are highly predictive of pauci‐immune GN in the appropriate context. While serum ANCA quantitation may not replace renal biopsy, reporting will assist in the decision to start treatment early for patients with organ or life‐threatening disease. [ABSTRACT FROM AUTHOR]

Objectives: In patients evaluated for hepatocellular carcinoma (HCC), magnetic resonance imaging (MRI) is often used secondarily when multiphase contrast-enhanced computed tomography (ceCT) is inconclusive. We investigated the clinical impact of adding MRI. Materials and methods: This single-institution retrospective study included 48 MRI scans (44 patients) conducted from May 2016 to July 2023 due to suspicion of HCC on a multiphase ceCT scan. Data included medical history, preceding and subsequent imaging, histology when available, and decisions made at multidisciplinary team meetings. Results: In case of possible HCC recurrence, 63% of the MRI scans were diagnostic of HCC. For 80% of the negative MRI scans, the patients were diagnosed with HCC within a median of 165 days in the suspicious area of the liver. In case of possible de-novo HCC in patients with cirrhosis, 22% of the scans were diagnostic of HCC and 33% of the negative MRI scans were of patients diagnosed with HCC within a median of 109 days. None of the non-cirrhotic patients with possible de-novo HCC and negative MRI scans (64%) were later diagnosed with HCC, but 3/5 of the indeterminate scans were of patients diagnosed with HCC in a biopsy. Conclusions: Secondary MRI to a multiphase ceCT scan suspicious of HCC is highly valuable in ruling out HCC in non-cirrhotic patients and in diagnosing HCC non-invasively in cirrhotic patients and patients with prior HCC. Patients with cirrhosis or prior HCC are still at high risk of having HCC if MRI results are inconclusive or negative. [ABSTRACT FROM AUTHOR]

Focused cardiac ultrasound (FoCUS) has emerged as a valuable tool in emergency and critical care medicine, allowing for rapid assessment of cardiac function and structure at the bedside. This rapid diagnostic technique holds particular promise in resource-limited settings like Ethiopia, where access to standard echocardiography may be limited and delayed. However, the accuracy of FoCUS interpretation is highly dependent on the operator's skills and expertise. To inform the design of effective interventions, the study aimed to assess the accuracy of FoCUS interpretation and associated factors among senior Emergency Medicine residents at two large referral teaching hospitals in Ethiopia. A cross-sectional study was conducted from October to December 2023 among 80 residents at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College. To assess diagnostic accuracy, 15 pre-selected cardiac ultrasound videos (normal and pathological cases) were selected from American College of Emergency Physicians website and the PoCUS Atlas, and accurate interpretation was defined as correctly answering at least 12 out of 15 readings. A binary logistic regression model was fitted to identify significant factors at the 5% level of significance, where significant results were interpreted using adjusted odds ratio (AOR) with 95% confidence interval (CI). The overall accuracy in interpreting FoCUS findings was 47.5% (95% CI: 38.8–60.0%), with highest for collapsing Inferior Vena Cava (91.3%) and standstill (90.0%), and lowest for Regional Wall Motion Abnormality of Left Ventricle (46.3%). Residents who received training (AOR=4.14, 95%CI:1.32–13.04, p = 0.015), perceived themselves as skilled (AOR=4.81, 95%CI=1.06–21.82, p = 0.042), and felt confident in acquiring and interpretation (AOR=3.16, 95%CI=1.01–9.82, p = 0.047) demonstrated significantly higher accuracy. The study identified a low overall accuracy in FoCUS interpretation, with accuracy improving with training and better perceived skill and confidence. Training programs with simulation, continuous education, and mentorship are crucial to enhance these critical skills. [ABSTRACT FROM AUTHOR]

Introduction: This narrative review aims to assess and compare the diagnostic accuracy of artificial intelligence (AI) techniques with ultrasound in the context of diagnosing rotator cuff pathology. Methods: A comprehensive search of electronic databases was conducted to identify relevant studies published from 2013 to 2023. Studies compared the diagnostic accuracy and precision of AI algorithms and ultrasound for rotator cuff pathology detection. Results: A total of eight studies met the inclusion criteria and were analysed. The review shows that AI techniques have shown promising results in diagnosing rotator cuff injuries, with reported comparative accuracy, specificity and sensitivity. Conclusion: The limited number of direct comparative studies makes it challenging to draw a definitive conclusion regarding superiority of one modality over another. However, the integration of AI in medical imaging holds significant potential to enhance diagnostic capabilities and streamline patient care. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate and compare the ability of large language models (LLMs) to diagnose various ailments in otolaryngology. Methods: We collected all 100 clinical vignettes from the second edition of Otolaryngology Cases—The University of Cincinnati Clinical Portfolio by Pensak et al. With the addition of the prompt "Provide a diagnosis given the following history," we prompted ChatGPT‐3.5, Google Bard, and Bing‐GPT4 to provide a diagnosis for each vignette. These diagnoses were compared to the portfolio for accuracy and recorded. All queries were run in June 2023. Results: ChatGPT‐3.5 was the most accurate model (89% success rate), followed by Google Bard (82%) and Bing GPT (74%). A chi‐squared test revealed a significant difference between the three LLMs in providing correct diagnoses (p = 0.023). Of the 100 vignettes, seven require additional testing results (i.e., biopsy, non‐contrast CT) for accurate clinical diagnosis. When omitting these vignettes, the revised success rates were 95.7% for ChatGPT‐3.5, 88.17% for Google Bard, and 78.72% for Bing‐GPT4 (p = 0.002). Conclusions: ChatGPT‐3.5 offers the most accurate diagnoses when given established clinical vignettes as compared to Google Bard and Bing‐GPT4. LLMs may accurately offer assessments for common otolaryngology conditions but currently require detailed prompt information and critical supervision from clinicians. There is vast potential in the clinical applicability of LLMs; however, practitioners should be wary of possible "hallucinations" and misinformation in responses. Level of Evidence: 3 Laryngoscope, 134:3997–4002, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Evaluate diagnostic accuracy of median nerve cross‐sectional area (CSA) to determine severity versus presence of carpal tunnel syndrome (CTS) across existing electrodiagnostic‐based (EDX) classification systems in patients with type 2 diabetes or bifid anatomy. Methods: Retrospective analysis of cross‐sectional patient data. Receiver operating characteristic analysis used to determine median nerve CSA cutoff values and associated diagnostic likelihood ratios for all consolidated and binary EDX‐based classifications of CTS in patients with type 2 diabetes or bifid anatomy. Determine shifts in diagnostic probability based on established cutoff values and associated likelihood ratios. Distal CSA measured at or near carpal tunnel inlet, proximal CSA at level of pronator quadratus muscle, and delta CSA by subtracting proximal from distal. Results: Binary categorizations of CTS were statistically superior to consolidated categorizations of CTS severity in patients with type 2 diabetes or bifid anatomy. Binary categorizations established reasonably consistent median nerve CSA cutoff values across all EDX‐based classifications examined resulting in the following for distal CSA or delta CSA: ≤10 or ≤4 mm2 to rule out and ≥11 or ≥5 mm2 to rule in CTS, respectively. These cutoff values resulted in small shifts in diagnostic probability in patients with type 2 diabetes and small to conclusive shifts in diagnostic probability in patients with bifid anatomy. Conclusions: Binary categorizations to rule out or rule in CTS based on the proposed cutoff values provide the most meaningful information about shifts in diagnostic probability across all EDX‐based classifications examined. The use of median nerve CSA to categorize severity of CTS is not recommended in patients with type 2 diabetes or bifid anatomy. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the diagnostic accuracy of median nerve cross‐sectional area (CSA) to determine the severity of carpal tunnel syndrome (CTS) vs the presence of CTS across existing electrodiagnostic‐based (EDX) classification systems. Methods: Retrospective analysis of cross‐sectional patient data. Receiver operating characteristic (ROC) analysis was used to determine CSA cutoff values and associated diagnostic likelihood ratios for all consolidated and binary EDX‐based classifications of CTS severity. Identification of CSA cutoff values associated with likelihood ratios capable of achieving conclusive (but at least moderate) shifts in diagnostic probability. Results: Binary categorizations of CTS (ie, "Normal" vs "Absent") were statistically superior to consolidated categorizations of CTS severity (ie, "Normal," "Mild," "Moderate," or "Severe"). Binary categorizations established consistent CSA cutoff values across all EDX‐based classifications examined and achieved conclusive shifts in diagnostic probability based on the following values of distal CSA or delta CSA: <7 or <1 mm2 to rule out and >13 or >7 mm2 to rule in CTS, respectively. Additionally, the following values of distal CSA and delta CSA may be used in certain circumstances because they produce only small shifts in diagnostic probability: ≤10 or ≤3 mm2 to rule out and ≥11 or ≥4 mm2 to rule in CTS, respectively. Conclusions: Using median nerve CSA to categorize the severity of CTS is not recommended based on lack of consistent and meaningful shifts in diagnostic probability. Rather, binary categorizations to rule out or rule in CTS based on the proposed CSA cutoff values consistently provided conclusive shifts in diagnostic probability across all EDX‐based classifications examined. [ABSTRACT FROM AUTHOR]

Background: Accurate diagnosis and spatial characterization of craniofacial fractures is critical for treatment planning and precise fracture reduction. Since augmented reality (AR) has potential for better diagnostic evaluation than traditional three-dimensional (3D) reformats, we tested whether our accessible mobile-based AR model improves diagnostic accuracy, spatial understanding, and decreases task cognitive load when clinicians evaluate facial fractures. Methods: Clinicians (n = 30) in specialties managing craniofacial trauma assessed a database of mandibular and maxillofacial complex fractures of varying severity using computed-tomography slices supplemented with either traditional 3D reformats (control) or the AR model (experimental), completed diagnostic and spatial characterization tasks, and were evaluated quantitatively and qualitatively on diagnostic accuracy, task cognitive load, and weighted preference for the traditional versus AR model. Results: Most clinicians (83%) preferred the AR model overall. Control and experimental groups had equivalent diagnostic sensitivity and specificity. Less experienced clinicians found the AR model required less effort, was less frustrating, and was preferred for fracture displacement characterization. The AR model had no significant impact on more experienced clinicians. All clinicians found the AR model allowed more intuitive manipulation of the 3D object. Those with less experience preferred the AR model over traditional imaging for diagnostic and educational purposes, whereas more experienced clinicians found that the AR model did not significantly alter their established approach to fracture evaluation. Conclusions: Our mobile-based AR model may be preferable to traditional 3D formats for spatial assessment tasks and decreasing task cognitive load, most notably for less experienced clinicians for whom perioperative practices are less established. [ABSTRACT FROM AUTHOR]

This study aimed to compare the findings of plain radiography and computed tomography (CT) of foot and ankle in patients submitted to the emergency department with high-energy foot and ankle trauma, to demonstrate if missing fractures on plain radiographs will significantly alter the treatment plan considered for each patient based on the findings of each imaging modality. We retrospectively observed standard radiological foot and ankle x-rays and CT scans in patients who presented to our center from April 2019 to June 2020 with a history of foot and ankle trauma with either loss of consciousness, a history of high-energy trauma, or clinical presentation disproportionate to plain radiographic findings. We investigated the number of fractures of each bone detected on plain radiographs and CT scans and the treatments based on each modality's findings in patients admitted to our center. Sixty-five out of 163 (39.87%) included in our study had at least one missed fracture on plain radiography that was detected on CT. Thirty-one (19%) patients had normal radiography despite actually having fractures. In 38 (23.31%) patients CT changed the treatment plan decided by our surgeons (P < 0.001). The two imaging modalities had a moderate agreement for detecting foot and ankle fractures overall (κ = 0.432). The failure to detect fractures in patients with high-energy trauma can significantly impact treatment effectiveness. Integrating CT scans into the diagnostic process can lead to changes in treatment planning and ultimately improve patient outcomes. Level of clinical evidence: IV. [ABSTRACT FROM AUTHOR]

Purpose: To summarize the abdominal computed tomography (CT) imaging and clinicopathological data of patients with SPNs of the pancreas and analyze the accuracy of preoperative CT diagnosis and features. Materials and methods: Between June 2006 and June 2023, CT images of 120 histopathologically proven SPNs in the pancreas were retrospectively reviewed. Fifteen features, including age, sex, and CT-determined features, were included in a multiple stepwise regression analysis. The correlations between features and SPNs, including odds ratios (ORs) and 95% confidence intervals (CIs), were evaluated. Results: Among the 120 patients, the diagnostic accuracy of CT was 43.3%. The baseline CT results of patients with a correct diagnosis and misdiagnosis revealed significant differences in sex (P = 0.043), age (P = 0.004), boundary (P = 0.037) and encapsulation (P = 0.002) between the two groups. The preoperative imaging diagnostic accuracy was significantly greater in females than in males (47.9% vs. 25.0%, P = 0.043). The immunohistochemical indices did not significantly differ between the two groups. The results of univariate analysis revealed significant differences in sex (P = 0.048), age (P = 0.014), tumor length (P = 0.023), tumor boundaries (P = 0.039) and capsule type (P = 0.003). The results of multivariate analysis revealed that encapsulation was closely related to the diagnostic accuracy of CT (P = 0.04). Conclusions: The accuracy of CT in the diagnosis of SPNs is low, but a length‒diameter ratio of the tumor approaching 1.0, encapsulation and clear boundaries are important CT-determined features. The capsule is an independent CT predictor in the diagnosis of SPNs. Key results: In this retrospective study of 120 participants with SPNs, the diagnostic accuracy of CT was 43.3% and, which was significantly greater in females than in males (47.9% vs. 25.0%, P = 0.043). Sex, age, tumor length, tumor boundaries and capsule type may indicate a diagnosis of SPNs, especially in the presence of a capsule. [ABSTRACT FROM AUTHOR]

Demand for emergency neuroimaging is increasing. Even magnetic resonance imaging (MRI) is often performed outside office hours, sometimes revealing more uncommon entities like brain tumors. The scientific literature studying artificial intelligence (AI) methods for classifying brain tumors on imaging is growing, but knowledge about the radiologist's performance on this task is surprisingly scarce. Our study aimed to tentatively fill this knowledge gap. We hypothesized that the radiologist could classify intra-axial brain tumors at the emergency department with clinically acceptable accuracy. We retrospectively examined emergency brain MRI reports from 2013 to 2021, the inclusion criteria being (1) emergency brain MRI, (2) no previously known intra-axial brain tumor, and (3) suspicion of an intra-axial brain tumor on emergency MRI report. The tumor type suggestion and the final clinical diagnosis were pooled into groups: (1) glial tumors, (2) metastasis, (3) lymphoma, and (4) other tumors. The final study sample included 150 patients, of which 108 had histopathological tumor type confirmation. Among the patients with histopathological tumor type confirmation, the accuracy of the MRI reports in classifying the tumor type was 0.86 for gliomas against other tumor types, 0.89 for metastases, and 0.99 for lymphomas. We found the result encouraging, given the prolific need for emergency imaging. [ABSTRACT FROM AUTHOR]

Background: Accurate detection of kidney damage is key to preventing renal failure, and identifying biomarkers is essential for this purpose. We aimed to assess the accuracy of miRNAs as diagnostic tools for chronic kidney disease (CKD). Methods: We thoroughly searched five databases (MEDLINE, Web of Science, Embase, Scopus, and CENTRAL) and performed a meta-analysis using R software. We assessed the overall diagnostic potential using the pooled area under the curve (pAUC), sensitivity (SEN), and specificity (SPE) values and the risk of bias by using the QUADAS-2 tool. The study protocol was registered on PROSPERO (CRD42021282785). Results: We analyzed data from 8351 CKD patients, 2989 healthy individuals, and 4331 people with chronic diseases. Among the single miRNAs, the pooled SEN was 0.82, and the SPE was 0.81 for diabetic nephropathy (DN) vs. diabetes mellitus (DM). The SEN and SPE were 0.91 and 0.89 for DN and healthy controls, respectively. miR-192 was the most frequently reported miRNA in DN patients, with a pAUC of 0.91 and SEN and SPE of 0.89 and 0.89, respectively, compared to those in healthy controls. The panel of miRNAs outperformed the single miRNAs (pAUC of 0.86 vs. 0.79, p < 0.05). The SEN and SPE of the panel miRNAs were 0.89 and 0.73, respectively, for DN vs. DM. In the lupus nephritis (LN) vs. systemic lupus erythematosus (SLE) cohorts, the SEN and SPE were 0.84 and 0.81, respectively. Urinary miRNAs tended to be more effective than blood miRNAs (p = 0.06). Conclusion: MiRNAs show promise as effective diagnostic markers for CKD. The detection of miRNAs in urine and the use of a panel of miRNAs allows more accurate diagnosis. Key Learning Points: 1. The diagnostic performance of miRNAs in chronic kidney diseases needs to be investigated, as previous systematic reviews and meta-analyses are scarce, and individual cohort studies have confirmed their importance in kidney pathophysiology. 2. Using multiple miRNAs as biomarkers can lead to more precise CKD diagnosis, as they outperform single miRNAs compared to healthy and people with chronic disease groups. The overall diagnostic accuracy of urinary miRNAs tended to be greater than that of blood samples, suggesting that they are noninvasive and readily available diagnostic markers in CKD patients. 3. Incorporating miRNAs as diagnostic markers for CKD in combination with traditional markers might improve the accuracy and efficiency of diagnosis. To optimize miRNA diagnostic performance, it is essential to consider the various biological sample types, comparison groups (control), and different kidney diseases. [ABSTRACT FROM AUTHOR]

Background: There is inconsistent evidence regarding the accuracy of GNAS mutations identification forthe diagnosis of FD/MAS. This study was performed to estimate the prevalence and diagnostic accuracy of GNAS mutations detection and to preliminarily investigate the genotype-phenotype correlation in FD patients. Methods: Five electronic databases were searched from 1995 to 2024 using search terms related to GNAS and fibrous dysplasia. Observational studies of FD patients undergoing GNAS mutation detection in FD were included. Results: A total of 878 FD patients were included. The pooled prevalence of GNAS mutations in FD based on the random effects model was 74% (95% CI = 64%-83%). Regarding diagnostic accuracy, a sensitivity of 0.83 (95% CI, 0.65-0.96), specificity of 0.99 (95% CI, 0.98-1.00) and the area under the receiver operating characteristic curve of 98.38% were found. Additionally, meta-analysis and Fisher's test showed the GNAS mutation types were significantly associated with FD types (OR = 3.51, 95% CI = 1.05 to 11.72; p < 0.05). Conclusion: A high detection rate of GNAS mutations occurred in FD, and its detection is reliable for diagnosing FD. Additionally, GNAS mutation type was types were significantly associated with FD type. [ABSTRACT FROM AUTHOR]

Context Aims Materials and Methods Results Conclusion The Modified Masood Scoring Index (MMSI) categorizes breast fine needle aspirates into four categories non‐proliferative breast diseases (PBD), PBD without atypia, PBD with atypia and carcinoma in situ/carcinoma. The International Academy of Cytology Yokohama System classifies the aspirates into five categories – inadequate, benign, atypical, suspicious, and malignant. Very few studies have been conducted so far to compare the diagnostic accuracy of this system.The objectives of the study were to classify breast fine needle aspirates according to the MMSI and IAC Yokohama and assess their risk of malignancy (ROM) and performance parameters.All breast FNAs received from June 2020 to May 2023 were classified according to the MMSI and IAC Yokohama. Using histopathological diagnosis as the gold standard, ROM and performance parameters were calculated.Out of the 559 breast fine needle aspirates, the histopathological correlation was available for 337 cases. The ROM for non‐PBD, PBD without atypia, PBD with atypia and carcinoma in situ/carcinoma categories were 0%, 1.2%, 9.1% and 93%, respectively. The ROM for each of the categories of Yokohama system was 16.6%, 1.1%, 4.3%, 86.2% and 97.6%, respectively. The values for the sensitivity, specificity, PPV, NPV and diagnostic accuracy were slightly higher for IAC Yokohama (97.3%, 97.2%, 94.7%, 98.6% and 97.2%, respectively) than the MMSI (96.4%, 96.2%, 93%, 98.1% and 96.3%, respectively). Furthermore, another shortfall of MMSI is the inability to compare the Inadequate category of the Yokohama system.Overall Yokohama system proved to be a better system for categorizing breast lesions on FNAB as the scoring system provides more objective categorization and minimizes false positive and false negative cases. [ABSTRACT FROM AUTHOR]

Background: Accurate diagnosis of laryngopharyngeal lesions is critical for effective treatment planning. While direct laryngoscopic biopsy (DLB) has been the traditional method, video laryngoscopic-guided biopsy (VLB) offers a less invasive alternative with potential benefits in visualization and patient comfort. This study aims to compare the diagnostic accuracy, patients outcome and procedural efficiency of VLB and DLB. Methods: A retrospective cohort study was conducted on 100 patients who underwent laryngeal biopsy between January 2022 and June 2023. Fifty patients underwent VLB, and fifty underwent DLB. Data on diagnostic yield, complication rates, procedure duration, and patientreported outcomes were collected and analyzed. Results: VLB demonstrated comparable diagnostic accuracy to DLB (94% vs. 96%, p=0.42). VLB had significantly lower complication rates (2% vs. 10%, p=0.03) and shorter procedure times (mean: 20 minutes vs. 35 minutes, p<0.01). Patients reported higher satisfaction with VLB, citing less discomfort and faster recovery. Conclusions: Video laryngoscopic-guided biopsy is a viable alternative to direct laryngoscopic biopsy, offering similar diagnostic accuracy with reduced complications and improved patient comfort. VLB may be considered a preferred method for the biopsy of laryngopharyngeal lesions in appropriate clinical settings. [ABSTRACT FROM AUTHOR]

Background This study was conducted to compare whole blood clotting time (20 minutes) with PT and APTT as early markers for hematotoxicity identification in snake bites. Early anti-snake venom administration can prevent hematotoxic consequences. Methods This study involved 94 patients who presented to the Department of General Medicine at the Karnataka Institute of Medical Sciences, KIMS Hospital, Hubballi, with a history ofsnakebites and characteristic clinical signs and symptoms. The study was conducted over a two-year period, from December 2020 to December 2022. The institutional ethics committee approved the study, and the participants provided written informed consent. Results Out of the 92 patients who had WBCT20 performed at admission, only 28 had positive results; the test's sensitivity in this study was 30.43%, and it missed 43% of cases with VICC. Additionally, two patients had normal coagulation profiles, and in both cases, WBCT20 was negative. These results indicate that WBCT20 has a high specificity of 100% in this study, as well as 100% PPV, 3.03% NPV, and 31.91% diagnostic accuracy. In contrast to previous research, the WBCT20 test's sensitivity, NPV, and diagnostic accuracy were low. There was also a significant likelihood that the coagulopathy in the cases would go unnoticed, which could delay ASV administration and raise the death and morbidity rates from snake bites. Conclusion In tertiary care hospitals managing instances of hematotoxic snake bites when PT-INR and APTT tests are feasible, prothrombin time is a very beneficial blood study in making an early diagnosis of coagulopathy compared to whole blood clotting tests. [ABSTRACT FROM AUTHOR]

Background Acute appendicitis is a common surgical emergency, and accurate imaging is crucial for diagnosis. This study aims to compare the diagnostic accuracy of ultrasound (US) and computed tomography (CT) imaging in adult patients presenting with symptoms suggestive of acute appendicitis. Methods A prospective study was conducted on 100 adult patients (50 males and 50 females) with a mean age of 35 years (range: 18-60 years). Each patient underwent both US and CT imaging. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both imaging modalities were calculated and compared. Results Ultrasound imaging demonstrated a sensitivity of 75% (95% CI: 64%-84%), specificity of 85% (95% CI: 75%-92%), PPV of 81% (95% CI: 70%-89%), and NPV of 80% (95% CI: 70%-88%). CT imaging showed a sensitivity of 94% (95% CI: 86%-98%), specificity of 90% (95% CI: 81%-96%), PPV of 92% (95% CI: 84%-97%), and NPV of 93% (95% CI: 85%-98%). The accuracy of US was 79%, while CT achieved 92%. Comparative analysis revealed that CT imaging had significantly higher sensitivity (p<0.05) than ultrasound, with no significant difference in specificity (p>0.05). Conclusion CT imaging demonstrates superior diagnostic accuracy and sensitivity compared to ultrasound in diagnosing acute appendicitis in adults, though both modalities have comparable specificity. CT should be preferred for its higher diagnostic confidence, especially in equivocal cases. [ABSTRACT FROM AUTHOR]

Background Abdominal trauma is a significant cause of morbidity and mortality, necessitating accurate and timely diagnosis for effective management. Contrast-enhanced CT (CECT) is widely utilized for evaluating abdominal injuries, but its diagnostic efficacy compared to other modalities like ultrasonography (FAST) and clinical examination warrants further investigation.This prospective study evaluates the role of contrast-enhanced CT (CECT) in the assessment of abdominal trauma, comparing its diagnostic accuracy with ultrasonography (FAST) and clinical examination Methods A total of 100 patients with abdominal trauma were included in this study. Patient demographics, injury mechanisms, organ injuries detected by CECT, severity of injuries (based on the AAST Organ Injury Scale), presence of hemoperitoneum, diagnostic accuracy of CECT, interventions based on CECT findings, complications, mortality rates, length of hospital stay, and follow-up outcomes were analyzed. Results The study comprised 65 males and 35 females, with the majority aged between 18-30 years. Road Traffic Accidents (50%) were the most common injury mechanism. CECT detected liver injuries in 30%, spleen in 25%, kidney in 20%, pancreas and intestines in 10% each, and multiple organs in 5%. Severity distribution was as follows: Grade I (20%), Grade II (25%), Grade III (30%), Grade IV (15%), and Grade V (10%). Hemoperitoneum was present in 40% of patients. CECT showed high diagnostic accuracy with 95% sensitivity, 90% specificity, 92% PPV, and 93% NPV. In comparison, FAST had 70% sensitivity and 75% specificity, while clinical examination had 65% sensitivity and 80% specificity. Interventions based on CECT findings included non-operative management (70%), surgical intervention (25%), and endovascular procedures (5%). Complications included infections (5%), re-bleeding (3%), and organ failure (2%). Mortality was 4%, predominantly due to severe multi-organ injury. The mean hospital stay was 10 days. At 3-month follow-up, 80% of patients had fully recovered, 15% had partial recovery, and 5% had long-term complications. Conclusion CECT is a highly sensitive and specific imaging modality for evaluating abdominal trauma, providing critical information for clinical management and significantly influencing patient outcomes. [ABSTRACT FROM AUTHOR]

Background Early detection of breast cancer significantly improves treatment outcomes and survival rates. While mammography is the standard screening tool, breast MRI is increasingly being used due to its higher sensitivity. This study aims to compare the diagnostic accuracy of mammography and breast MRI in detecting early breast cancer. Methods A total of 100 women aged 35-70 years (mean age: 52) participated in this study. Each participant underwent both mammography and breast MRI. Diagnostic measures calculated included true positives (TP), true negatives (TN), false positives (FP), and false negatives (FN). From these, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were derived for both diagnostic methods. Results Mammography identified 60 TP, 25 TN, 10 FP, and 5 FN cases. The sensitivity of mammography was 92.3%, specificity was 71.4%, PPV was 85.7%, NPV was 83.3%, and accuracy was 85.0%. Breast MRI identified 62 TP, 30 TN, 5 FP, and 3 FN cases. The sensitivity of breast MRI was 95.4%, specificity was 85.7%, PPV was 92.5%, NPV was 90.9%, and accuracy was 92.0%. Comparative analysis showed that breast MRI had higher sensitivity, specificity, PPV, NPV, and overall accuracy than mammography. Conclusion Breast MRI outperforms mammography in detecting early breast cancer, exhibiting superior sensitivity, specificity, PPV, NPV, and accuracy. Breast MRI identified more true positive cases and had fewer false negatives and false positives. These results suggest that breast MRI may be a more reliable diagnostic tool for early breast cancer detection. However, factors such as cost, availability, and patient-specific circumstances should be considered when choosing the diagnostic method. [ABSTRACT FROM AUTHOR]

Background The World Health Organization–approved Xpert MTB/XDR test detects Mycobacterium tuberculosis and resistance to isoniazid, fluoroquinolones, ethionamide, and injectable drugs directly in specimens. This pragmatic, laboratory-based study assessed the diagnostic accuracy and feasibility of a reflex testing approach, where Xpert MTB/XDR was performed on residual specimens previously processed for Xpert MTB/RIF Ultra. Methods Routine respiratory specimens, processed for Xpert MTB/RIF Ultra, were stored in sample reagent buffer at 2°C–8°C. If rifampicin resistant, the residual specimen was assessed for adequate volume (≥2 mL) and tested with Xpert MTB/XDR, with storage time recorded. A second specimen was used for routine and reference standard testing (culture and sequencing). Results Specimens (99% sputum) from 763 participants submitted to 2 large routine laboratories were included. Xpert MTB/XDR yielded valid resistance detection results in 639 (84%), compared with 507 (66%) for routine testing (difference [95% CI], 18% [13%–22%]). The median turnaround time for results was 23 hours for Xpert MTB/XDR and 15 days for routine testing. While 748 specimens (98%) were ≥2 mL, only 102 (13%) were stored for ≤4 hours. By the reference standard, 284 of 394 (72%) were isoniazid resistant, and 57 of 380 (15%) were fluroquinolone resistant. The sensitivities of Xpert MTB/XDR were 94% (95% CI, 91%–97%) for isoniazid and 91% (81%–97%) for fluoroquinolone resistance detection. The specificities were 98% (94%–100%) and 100% (98%–100%), respectively. Conclusions Xpert MTB/XDR performed favorably compared with the reference, and the reflex testing approach increased results availability over routine testing, while dramatically decreasing turnaround time from weeks to hours. Laboratory workflow precluded testing within the manufacturer-recommended 4-hour storage time, but longer storage did not appear detrimental. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions There are no recommendations regarding the optimal puncture site in endoscopic ultrasound‐guided fine needle biopsy (EUS‐FNB). This multicenter randomized prospective study compared the diagnostic accuracy and histological findings according to the sampling site for pancreatic masses larger than 3 cm.Consecutive patients with pancreatic masses larger than 3 cm indicated for EUS‐FNB were included in the study. Patients were randomly assigned to two groups for the initial puncture site (central vs. peripheral sampling of the masses). A minimum of four passes were performed, alternating between the center and the periphery. The primary outcome was diagnostic accuracy.A total of 100 patients were equally divided into the central group and the peripheral group. The final diagnosis revealed malignancy in 95 patients (pancreatic cancer [n = 89], neuroendocrine tumor [n = 4], lymphoma [n = 1], metastatic carcinoma [n = 1]), and benign conditions in five patients (chronic pancreatitis [n = 4], autoimmune pancreatitis [n = 1]). There was no significant difference in diagnostic accuracy between the puncture sites. However, combining samples from both areas resulted in higher diagnostic accuracy (97.0%) compared to either area alone, with corresponding values of 88.0% for the center (P = 0.02) and 85.0% for the periphery (P = 0.006).Both central sampling and peripheral sampling showed equivalent diagnostic accuracy in detecting malignancy. However, combining samples from both areas generated superior diagnostic yield compared to using either sampling site alone. For pancreatic masses larger than 3 cm, it is advisable to consider sampling from various areas of the masses to maximize the diagnostic yield. [ABSTRACT FROM AUTHOR]

Our research evaluates advanced artificial (AI) methodologies to enhance diagnostic accuracy in pulmonary radiography. Utilizing DenseNet121 and ResNet50, we analyzed 108,948 chest X-ray images from 32,717 patients and DenseNet121 achieved an area under the curve (AUC) of 94% in identifying the conditions of pneumothorax and oedema. The model's performance surpassed that of expert radiologists, though further improvements are necessary for diagnosing complex conditions such as emphysema, effusion, and hernia. Clinical validation integrating Latent Dirichlet Allocation (LDA) and Named Entity Recognition (NER) demonstrated the potential of natural language processing (NLP) in clinical workflows. The NER system achieved a precision of 92% and a recall of 88%. Sentiment analysis using DistilBERT provided a nuanced understanding of clinical notes, which is essential for refining diagnostic decisions. XGBoost and SHapley Additive exPlanations (SHAP) enhanced feature extraction and model interpretability. Local Interpretable Model-agnostic Explanations (LIME) and occlusion sensitivity analysis further enriched transparency, enabling healthcare providers to trust AI predictions. These AI techniques reduced processing times by 60% and annotation errors by 75%, setting a new benchmark for efficiency in thoracic diagnostics. The research explored the transformative potential of AI in medical imaging, advancing traditional diagnostics and accelerating medical evaluations in clinical settings. [ABSTRACT FROM AUTHOR]

Objective To develop the optimal US scanning protocol for the diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease. Methods In this cross-sectional study, consecutive patients with a crystal-proven diagnosis of CPPD disease, and age-, sex-matched disease controls with a negative synovial fluid analysis were prospectively enrolled in two Italian Institutions. Four rheumatologists, blinded to patients' clinical details, performed US examinations using a standardized scanning protocol including 20 joints (shoulders, elbows, wrists, metacarpophalangeal joints from second to fifth fingers, hips, knees, ankles). CPPD was identified as presence/absence, according to the OMERACT definitions. Reduced US scanning protocols were developed by selecting the most informative joints to be imaged by US using the LASSO technique. Patients were randomly divided into training and validation sets. Their diagnostic accuracy was tested comparing the area under the receiver operating characteristic curves. Results The number of participants enrolled was 204: 102 with CPPD disease and 102 disease controls [age, mean (s. d.): 71.3 (12.0) vs 71.1 (13.5) years; female: 62.8% vs 57.8%]. The median number of joints with US evidence of CPPD was 5 [interquartile range (IQR): 4–7] and 0 (IQR: 0–1) in patients with CPPD disease and controls, respectively (P  < 0.01). The detection of CPPD in ≥2 joints using a reduced scanning protocol (bilateral assessment of knees, wrists and hips) showed a sensitivity of 96.7% (95% CI: 82.8, 99.9) and a specificity of 100 (95% CI: 88.8, 100.0) for the diagnosis of CPPD disease and had good feasibility [mean (s. d.): 12.5 (5.3) min]. Conclusion Bilateral US assessment of knees, wrists and hips had excellent accuracy and good feasibility for the diagnosis of CPPD disease. [ABSTRACT FROM AUTHOR]

Identifying auditory impairments early in newborns is essential to prevent developmental delays. Otoacoustic Emissions (OAE) screenings play a critical role in newborn hearing assessments. However, the ideal timing post-birth for these tests remains unclear. This study evaluates the efficacy of OAE screenings within the first five days after birth to determine the most effective timing. An observational study involved 1,013 full-term neonates at a tertiary care centre. These neonates underwent Transient Evoked Otoacoustic Emissions (TEOAE) screenings daily from Day 1 to Day 5, following WHO and JCIH guidelines. The study assessed pass rates, false positives, and false negatives, with follow-up screenings at one and three months for neonates with initial ambiguous results. The study found that screening efficiency significantly increased, with Day 1 pass rates at 8% (81 neonates) and 98% (992 neonates) by Day 5, marking a significant improvement in diagnostic accuracy (p < 0.001). False positive rates dropped from 92% on Day 1 to 2% by Day 5, and false negatives decreased to below 1%. Sensitivity and specificity reached their peak at 98% and 99.5%, respectively, on Day 5. Our study findings advocate for adjusting neonatal hearing screening protocols to include OAE tests on the fifth day post-birth, optimizing clinical efficacy through enhanced diagnostic accuracy and reducing the logistical and emotional burdens on families and healthcare providers. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study evaluated the efficacy of the TrueLab™ Real Time mini-PCR system in providing rapid and accurate diagnostic results for tuberculosis (TB) detection in India. The goal is to improve case detection and accelerate treatment in settings with limited resources. Materials and Methods: This prospective study was conducted by the Department of Microbiology on 120 patients, age ranging from >=15 years with at least two clinical symptoms of pulmonary TB. Molbio and Universal Cartridge Based Sample Prep were the 2 methods used for processing sputum samples. The diagnosis was based on the MTB Real Time PCR test, which has a detection limit of 100 CFU/mL. Patients under 15 years, samples lacking clinical background, saliva specimens or extra-pulmonary TB cases were excluded from the study. Results: A total of 44.17% samples were positive for TB with maximum positivity in the age group 31-45 years. Positivity rate was found to be higher in females. In 4.17% of cases there was rifampicin resistance, which was significantly high in previously treated cases. Comparison of Truenat with Ziehl-Neelsen and fluorescent method revealed that it was more sensitive and less time consuming. Conclusion: Truenat MTB/RIF is a sensitive detection system for TB with rapid results, which serves as an important tool in the early management of tuberculosis patients and drug-resistant-TB cases. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infections (UTIs) have been one of the most common bacterial infections in clinical practice worldwide. Artificial intelligence (AI) and machine learning (ML) based algorithms have been increasingly applied in UTI case identification and prediction. However, the overall performance of AI/ML algorithms in identifying and predicting UTI has not been evaluated. The purpose of this paper is to quantitatively evaluate the application value of AI/ML in identifying and predicting UTI cases. Methods: MEDLINE, EMBASE, Web of Science, and PubMed databases were systematically searched for articles published up to December 31, 2023. Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) and Prediction Model Risk of Bias Assessment Tool (PROBAST) were used to assess the risk of bias. Study characteristics and detailed algorithm information were extracted. Pooled sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were synthesized using a bivariate mix-effects model. Meta-regression and subgroup analysis were conducted to test the source of heterogeneity. Results: In total, 11 studies with 14 AI/ML models were included in the final meta-analysis. The overall pooled AUC was 0.89 (95%CI 0.86–0.92). Additionally, the pooled Sen, Spe, PLR, NLR, and DOR were 0.78 (95%CI 0.71–0.84), 0.89 (95%CI 0.83–0.93), 6.99 (95%CI 4.38–11.14), 0.25 (95%CI 0.18–0.34) and 28.07 (95%CI 14.27–55.20), respectively. The results of meta-regression suggested that reference standard definitions might be the source of heterogeneity. Conclusion: AI/ML algorithms appear to be promising to help clinicians detect and identify patients at high risk of UTIs. However, further studies are demanded to evaluate the application value of AI/ML more thoroughly. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate and compare the diagnostic accuracy of modalities used to aid the diagnosis of aseptic knee arthroplasty loosening. Methods: A comparative diagnostic test accuracy systematic review and meta‐analysis was conducted following the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines. PubMed, EMBASE and Cochrane databases were searched for original articles evaluating diagnostic modalities up to March 2024. Included studies compared the modality (index test) to the intraoperative finding as reference test. The QUADAS‐C (Quality Assessment of Diagnostic Accuracy Studies‐Comparative) tool was used to assess the quality of the included studies. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to evaluate the certainty of evidence. Level of evidence was evaluated using the Oxford Levels of Evidence tool. The primary outcome was the summary of diagnostic accuracy metrics for each modality as demonstrated by a summary receiver‐operating characteristic (SROC) curve. Results: The search yielded 467 articles. Of these, 14 articles were included. These 14 articles evaluated a total of five different diagnostic modalities: bone scintigraphy (three studies, 146 cases), 18‐fluorodeoxyglucose positron emission tomography (two studies, 50 cases), single‐photon emission computed tomography combined with computed tomography (SPECT/CT) (seven studies, 371 cases), radionuclide arthrogram (three studies, 196 cases) and magnetic resonance imaging (MRI) (one study, 116 cases). Nine studies exhibited a high risk of bias in patient selection, and all studies showed a high risk of bias related to the reference test. The majority of the included studies were classified as Level III evidence, leading to an overall low level of certainty in the evidence. The most accurate tests, as demonstrated by the SROC analysis, were MRI and SPECT/CT, with sensitivities ranging from 0.00 to 1.00 and 0.33 to 1.00 and specificities between 0.31–1.00 and 0.00–1.00, respectively. Conclusions: This review and meta‐analysis evaluated available diagnostic modalities to aid the diagnosis of knee arthroplasty loosening and based on a low certainty of evidence suggests that MRI and SPECT/CT are currently the most accurate modalities available to aid the diagnosis of aseptic loosening of knee arthroplasty components. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Objective: To determine the accuracy of salivary active matrix metalloproteinase (aMMP)‐8 point‐of‐care test (POCT) for detecting periodontitis in adults, through meta‐analysis. Materials and Methods: Diagnostic studies evaluating the accuracy of salivary/oral rinse aMMP‐8 POCT for detecting periodontitis in adults, when compared with clinical examination, were considered eligible. A comprehensive search was performed up to 31 August 2023 through five databases. Quality Assessment of Diagnostic Accuracy Studies 2 was utilized to evaluate the methodological quality of the included articles. Meta‐analysis was performed using Bayesian bivariate hierarchical model and subgroup analysis. Results: From 368 screened studies, 6 studies (4 cross‐sectional and 2 longitudinal studies) were included in the meta‐analysis. Overall, the pooled sensitivity and specificity of salivary aMMP‐8‐POCT for detecting periodontitis were 0.63 (95% CI: 0.41–0.82) and 0.84 (95% CI: 0.65–0.95), respectively. Subgroup analyses revealed that the 95% CI for oral fluid types, predefined diagnostic thresholds and the POCT systems largely overlapped, indicating that the differences between them may not be significant. Conclusion: Salivary aMMP‐8 POCT shows fair accuracy for detecting periodontitis. The diagnostic accuracy cannot be significantly influenced by the types of oral fluids, predefined diagnostic thresholds or the specific POCT systems used. More research is needed to confirm the clinical utility and implementation of aMMP‐8 POCT in the diagnosis of periodontitis. [ABSTRACT FROM AUTHOR]

Purpose: Cerebrospinal fluid (CSF) granulocytes are associated with bacterial meningitis, but information on its diagnostic value is limited and primarily based on retrospective studies. Therefore, we assessed the diagnostic accuracy of CSF granulocytes. Methods: We analyzed CSF granulocytes (index test) from all consecutive patients in two prospective cohort studies in the Netherlands. Both studies included patients ≥ 16 years, suspected of a central nervous system (CNS) infection, who underwent a diagnostic lumbar puncture. All episodes with elevated CSF leukocytes (≥ 5 cells per mm3) were selected and categorized by clinical diagnosis (reference standard). Results: Of 1261 episodes, 625 (50%) had elevated CSF leukocytes and 541 (87%) were included. 117 of 541 (22%) were diagnosed with bacterial meningitis, 144 (27%) with viral meningoencephalitis, 49 (9%) with other CNS infections, 76 (14%) with CNS autoimmune disorders, 93 (17%) with other neurological diseases and 62 (11%) with systemic diseases. The area under the curve to discriminate bacterial meningitis from other diagnoses was 0.97 (95% confidence interval [CI] 0.95–0.98) for CSF granulocyte count and 0.93 (95% CI 0.91–0.96) for CSF granulocyte percentage. CSF granulocyte predominance occurred in all diagnostic categories. A cutoff at 50% CSF granulocytes gave a sensitivity of 94% (95% CI 90–98), specificity of 80% (95% CI 76–84), negative predictive value of 98% (95% CI 97–99) and positive predictive value of 57% (95% CI 52–62). Conclusion: CSF granulocytes have a high diagnostic accuracy for bacterial meningitis in patients suspected of a CNS infection. CSF granulocyte predominance occurred in all diagnostic categories, limiting its value in clinical practice. [ABSTRACT FROM AUTHOR]

The ever‐increasing popularity of standardized systems for reporting cytopathology has led in part to much attention to and importance of the risk stratification schemes, especially the risks of malignancy (ROMs), which are associated with the different diagnostic categories and upon which recommendations for clinical management are based. However, it is well known that the ROM calculations are based on retrospective reviews of the existing literature, representing a heterogeneous patient population, and are plagued by significant biases and variations. Statistically, the ROM represents the post‐test probability of malignancy, which changes with the test result and with the prevalence of malignancy (or pretest probability) in an individual practice setting and individual patient presentation. Therefore, the clinical utility of the ROM is questioned and likely needs a second look in the nongynecologic cytopathology reporting systems. In this communication, the authors discuss the status of the ROM estimates according to the most commonly used nongynecologic reporting systems, including for thyroid, salivary glands, and others, highlighting similarities and differences with a focus on the limitations of ROM estimates and their application in clinical practice. Standardized systems for reporting cytopathology have grown in popularity, and the risk‐stratification schemes in such reporting systems have gained in importance, especially the risk of malignancy (ROM). The status of ROM estimation according to the most commonly used nongynecologic reporting systems is discussed, highlighting similarities and differences and focused on the limitations of ROM estimates and their application in clinical practice. [ABSTRACT FROM AUTHOR]

Specimens collected from dead pigs are a welfare-friendly and cost-effective active surveillance. This study aimed to evaluate the accuracy of different postmortem specimens from dead piglets for disease detection, using PRRSV as an example. Three farrow-to-wean farms undergoing PRRSV elimination were conveniently selected. Samples were collected at approximately 8- and 20-weeks post-outbreak. Postmortem specimens included nasal (NS), oral (OS), and rectal (RS) swabs, tongue-tip fluids (TTF), superficial inguinal lymph nodes (SIL), and intracardiac blood. These were tested individually for PRRSV by RT-PCR. Sensitivity, specificity, negative and positive predictive values, and agreement of postmortem specimens were calculated using intracardiac sera as the gold standard. OS and SIL had the best overall performance, with sensitivities of 94.6–100%, specificities of 83.9–85.1%, and negative predictive values of 97.3–100%. TTF had high sensitivity (92.2%) but low specificity (53.9%) and positive predictive value (48.3%). While challenges in meeting sampling targets due to variable pre-weaning mortality were noted, PRRS was detected in all postmortem specimens. OS and NS showed promising results for disease monitoring, though TTF, despite their sensitivity, had lower specificity, making them less suitable for individual infection assessment but useful for assessing environmental contamination. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Our objective was to determine whether the educational game SonoQz can improve diagnostic performance in ultrasound assessment of ovarian tumors.The SonoQz mobile application was developed as an educational tool for medical doctors to practice ultrasound assessment, based on still images of ovarian tumors. The game comprises images from 324 ovarian tumors, examined by an ultrasound expert prior to surgery. A training phase, where the participants assessed at least 200 cases in the SonoQz app, was preceded by a pretraining test, and followed by a posttraining test. Two equal tests (A and B), each consisting of 20 cases, were used as pre‐ and posttraining tests. Half the users took test A first, B second, and the remaining took the tests in the opposite order. Users were asked to classify the tumors (1) according to International Ovarian Tumor Analysis (IOTA) Simple Rules, (2) as benign or malignant, and (3) suggest a specific histological diagnosis. Logistic mixed models with fixed effects for pre‐ and posttraining tests, and crossed random effects for participants and cases, were used to determine any improvement in test scores, sensitivity, and specificity.Fifty‐eight doctors from 19 medical centers participated. Comparing the pre‐ and posttraining test, the median of correctly classified cases, in Simple Rules assessment increased from 72% to 83%, p < 0.001; in classifying the lesion as benign or malignant tumors from 86% to 95%, p < 0.001; and in making a specific diagnosis from 43% to 63%, p < 0.001. When classifying tumors as benign or malignant, at an unchanged level of sensitivity (98% vs. 97%, p = 0.157), the specificity increased from 70% to 89%, p < 0.001.Our results indicate that the educational game SonoQz is an effective tool that may improve diagnostic performance in assessing ovarian tumors, specifically by reducing the number of false positives while maintaining high sensitivity. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) causes major public health problems worldwide. Fighting TB requires sustained efforts in health prevention, diagnosis and treatment. Previous literature has shown that conventional diagnostic methods like X-ray and sputum microscopy often miss early or extrapulmonary TB due to their limited sensitivity. Blood tests, while useful, lack the anatomical detail needed for precise localization of TB lesions. A possible step forward in the fight against TB could be the use of Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and Computed Tomography (CT). This meta-analysis discusses the current literature, including the methods, results and implications of using FDG-PET-CT in the early diagnosis of TB. Analysis of the studies showed that the sensitivity of FDG-PET-CT as a potential method for early detection of TB was 82.6%. [ABSTRACT FROM AUTHOR]

The wide range of clinical and serological manifestations in systemic lupus erythematosus (SLE) and the lack of accepted diagnostic criteria warrant the identification of novel, more accurate biomarkers. Hematological indices derived from full blood cell counts, particularly the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), have shown promise in SLE; however, a critical appraisal of their diagnostic accuracy is lacking. We sought to address this issue by conducting a systematic review and meta-analysis of the diagnostic accuracy of the NLR and PLR in SLE. The electronic databases PubMed, Scopus, and Web of Science were systematically searched from inception to 15 March 2024 for studies reporting the sensitivity and specificity of the NLR and PLR, obtained by receiver operating characteristic (ROC) curve analysis, for the presence of SLE, disease severity, organ involvement (lupus nephritis, pericarditis, and pleural disease), and complications (infections). The risk of bias was assessed using the JBI Critical Appraisal Checklist (PROSPERO registration number: CRD42024531446). The NLR exhibited good accuracy for the diagnosis of SLE (eight studies; area under the curve, AUC = 0.81, 95% CI 0.78–0.85) and lupus nephritis (nine studies; AUC = 0.81, 95% CI 0.77–0.84), but not for severe disease (nine studies; AUC = 0.69, 95% CI 0.65–0.73) or infections (six studies; AUC = 0.73, 95% CI 0.69–0.77). The PLR exhibited good accuracy for the diagnosis of severe disease (six studies; AUC = 0.85, 95% CI 0.81–0.87). There were an insufficient number of studies to assess the accuracy of the PLR for the diagnosis of SLE, lupus nephritis, or infections. No study investigated the NLR and PLR in SLE patients with pericarditis or pleural disease. Therefore, the NLR and the PLR have a relatively high diagnostic accuracy for the presence of SLE and lupus nephritis (NLR) and severe disease (PLR). Further studies are warranted to determine whether the NLR and PLR, in combination with clinical evaluation and other serological biomarkers, can enhance the diagnosis and management of SLE. [ABSTRACT FROM AUTHOR]

Introduction: Lymph node enlargement is common in children, with 90% of physiologically palpable lymph nodes. This study aimed to develop a predictive model based on clinical characteristics to enhance the diagnosis of pediatric lymphadenopathy and provide insights into biopsy outcomes. Materials and methods: A clinical prediction rule was developed using a retrospective, cross-sectional design for patients under 15 years who underwent lymph node biopsy from 2012 to 2022. Multivariable risk regression was used to analyze benign and malignant lesions, presenting results through risk difference and AUROC for each group. Predicted probabilities were applied in a logistic regression equation to classify patients' lymphadenopathy as reactive hyperplasia, benign, or malignant. Results: Of 188 children, 70 (37.2%) had benign lymphadenopathy beyond reactive hyperplasia, and 27 (14.4%) had malignant lymphadenopathy. The predictive model included 12 characteristics such as size, location, duration, associated symptoms, and lymph node examination. Predictive accuracy was 92.2% for benign cases (AUROC = 0.92; 95% CI 0.87–0.96) and 98.6% for malignancy (AUROC = 0.98; 95% CI 0.94–0.99). Overall accuracy for predicting both benign and malignant tumors was 68.3%. Conclusion: The model demonstrated reasonably accurate predictions for the clinical characteristics of pediatric lymphadenopathy. It tended to overestimate malignancy but did not miss diagnoses, aiding in reducing unnecessary lymph node biopsies in benign cases. [ABSTRACT FROM AUTHOR]

BackgroundMethodsResultsConclusionCushing’s syndrome (CS) poses diagnostic challenges, particularly in distinguishing pituitary-dependent Cushing’s syndrome, Cushing’s disease (CD), from the ectopic ACTH syndrome (EAS). This study evaluated the diagnostic value of the desmopressin stimulation test (DST) in patients with ACTH-dependent CS in helping this discrimination.Twenty-three ACTH-dependent CS patients underwent sequential DST, bilateral inferior petrosal sinus sampling (BIPSS), and transsphenoidal surgery (TSS). Two definitions of a positive DST results were applied. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios. To avoid bias from predetermined criteria, we generated univariate receiver-operating characteristic (ROC) curves, plotting sensitivity against 1-specificity at various percentage cortisol and ACTH response levels.Against BIPSS, DST demonstrated robust sensitivity (Definition 1: 90.0%, Definition 2: 76.2%) and overall accuracy (Definition 1: 87.0%, Definition 2: 73.9%). PPV was high (Definition 1: 95.0%, Definition 2: 94.1%), but NPV indicated potential false negatives. Compared to TSS, DST showed good sensitivity (Definition 1: 90.9–77.3%) and PPV (100.0%) but limited NPV (16.7%). The likelihood ratios emphasized the diagnostic value of the test. Notably, against TSS, DST showed perfect discriminatory power (AUC 1.000 for percent ACTH, 0.983 for percent cortisol).The desmopressin test shows promise in accurately identifying the underlying cause of ACTH-dependent CS, potentially reducing the reliance on invasive procedures and providing a practical solution for managing complex cases. Further research with larger cohorts is required to validate the utility of the DST in routine clinical practice. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Temporomandibular disorders (TMDs) pose diagnostic challenges, and selecting appropriate imaging modalities is crucial for accurate assessment. This study aimed to compare the diagnostic accuracy and efficacy of ultrasonography (US) and magnetic resonance imaging (MRI) in identifying TMDs.A comprehensive meta‐analysis was conducted, including studies that compared US and MRI for TMJ disorder assessments. Fixed‐effects models were utilized to calculate pooled odds ratios (ORs) and relative risks (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the chi‐squared test and I2 statistic. Newcastle–Ottawa scale was used to assess the methodological quality of the studies included.Six studies were included, involving a total of 281 participants. The meta‐analysis demonstrated that MRI was statistically somewhat better than US in identifying TMJ disorders. The summary OR was 0.64 (95% CI: 0.46–0.90), and the summary RR was 0.80 (95% CI: 0.68–0.95). Heterogeneity among the studies was low (χ2 = 2.73, df = 5, p = .74; I2 = 0%). Demographic variables revealed variations in sample size, gender ratio and mean age across the studies.This meta‐analysis provides evidence that MRI may be more effective than US in diagnosing TMDs. However, the study is limited by the small number of included studies and variations in demographic variables and study designs. Future research with larger samples and standardised protocols is essential to confirm and strengthen these findings. Understanding the diagnostic accuracy of MRI and US for TMJ disorders will aid clinicians in making informed decisions for effective TMJ disorder assessments and patient management. [ABSTRACT FROM AUTHOR]

Introduction: Early and adequate preliminary diagnosis reduce emergency department (ED) and hospital stay and may reduce mortality. Several studies demonstrated adequate preliminary diagnosis as stated by emergency medical services (EMS) ranging between 61 and 77%. Dutch EMS are highly trained, but performance of stating adequate preliminary diagnosis remains unknown. Methods: This prospective observational study included 781 patients (> 18years), who arrived in the emergency department (ED) by ambulance in two academic hospitals. For each patient, the diagnosis as stated by EMS and the ED physician was obtained and compared. Diagnosis was categorized based on the International Classification of Diseases, 11th Revision. Results: The overall diagnostic agreement was 79% [95%-CI: 76–82%]. Agreement was high for traumatic injuries (94%), neurological emergencies (90%), infectious diseases (84%), cardiovascular (78%), moderate for mental and drug related (71%), gastrointestinal (70%), and low for endocrine and metabolic (50%), and acute internal emergencies (41%). There is no correlation between 28-day mortality, the need for ICU admission or the need for hospital admission with an adequate preliminary diagnosis. Conclusion: In the Netherlands, the extent of agreement between EMS diagnosis and ED discharge diagnosis varies between categories. Accuracy is high in diseases with specific observations, e.g., neurological failure, detectable injuries, and electrocardiographic abnormalities. Further studies should use these findings to improve patient outcome. [ABSTRACT FROM AUTHOR]

Medical imaging stands as a critical component in diagnosing various diseases, where traditional methods often rely on manual interpretation and conventional machine learning techniques. These approaches, while effective, come with inherent limitations such as subjectivity in interpretation and constraints in handling complex image features. This research paper proposes an integrated deep learning approach utilizing pre-trained models—VGG16, ResNet50, and InceptionV3—combined within a unified framework to improve diagnostic accuracy in medical imaging. The method focuses on lung cancer detection using images resized and converted to a uniform format to optimize performance and ensure consistency across datasets. Our proposed model leverages the strengths of each pre-trained network, achieving a high degree of feature extraction and robustness by freezing the early convolutional layers and fine-tuning the deeper layers. Additionally, techniques like SMOTE and Gaussian Blur are applied to address class imbalance, enhancing model training on underrepresented classes. The model's performance was validated on the IQ-OTH/NCCD lung cancer dataset, which was collected from the Iraq-Oncology Teaching Hospital/National Center for Cancer Diseases over a period of three months in fall 2019. The proposed model achieved an accuracy of 98.18%, with precision and recall rates notably high across all classes. This improvement highlights the potential of integrated deep learning systems in medical diagnostics, providing a more accurate, reliable, and efficient means of disease detection. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) affects a significant proportion of the global population, with many having moderate or severe forms of the disease. Home Sleep Apnea Testing (HSAT) has become the most common method of diagnosing OSA, replacing in-lab polysomnography. Polysmith software Version 11 by Nihon Kohden allows for the automatic scoring of respiratory events. This study aimed to assess the validity of this technology. Study Objectives: The objective was to assess the accuracy of the Polysmith Software Automatic Scoring Algorithm of HSATs in comparison to that of sleep technicians. Methods: One hundred twenty HSATs were scored by both sleep technicians and Polysmith software. The measured values were the respiratory event index (REI), apneic events, and hypopneic events. Agreement between the two methods was reached by utilizing the Kruskal–Wallis test, Pearson correlation coefficient, and Bland–Altman plot, as well as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The correlation between the REI calculated by the software and technicians proved to be strong overall (r = 0.96, p < 0.0001). The mild OSA group had a moderate correlation (r = 0.45, p = 0.0129). The primary snoring, moderate OSA, and severe OSA groups showed stronger correlations (r = 0.69, p < 0.0001; r = 0.56, p = 0.012; r = 0.71, p < 0.0001). The analysis conducted across all groups demonstrated an average sensitivity of 81%, specificity of 94%, PPV of 82%, and NPV of 94%, with an overall accuracy of 81%. When combining the moderate and severe OSA groups into a single category, the sensitivity was 90%, specificity was 100%, PPV was 100%, and NPV was 91%. Conclusions: OSA can be reliably diagnosed from HSATs with the automated Polysmith software across all OSA disease severity groups, with higher levels of accuracy in moderate/severe OSA and lower levels of accuracy in mild OSA. [ABSTRACT FROM AUTHOR]

Background: In recent years, there has been an increasing effort to take advantage of the potential use of low magnetic induction devices with less than 1 T, referred to as Low-Field MRI (LF MRI). LF MRI systems were used, especially in the early days of magnetic resonance technology. Over time, magnetic induction values of 1.5 and 3 T have become the standard for clinical devices, mainly because LF MRI systems were suffering from significantly lower quality of the images, e.g., signal–noise ratio. In recent years, due to advances in image processing with artificial intelligence, there has been an increasing effort to take advantage of the potential use of LF MRI with induction of less than 1 T. This overview article focuses on the analysis of the evidence concerning the diagnostic efficacy of modern LF MRI systems and the clinical comparison of LF MRI with 1.5 T systems in imaging the nervous system, musculoskeletal system, and organs of the chest, abdomen, and pelvis. Methodology: A systematic literature review of MEDLINE, PubMed, Scopus, Web of Science, and CENTRAL databases for the period 2018–2023 was performed according to the recommended PRISMA protocol. Data were analysed to identify studies comparing the accuracy, reliability and diagnostic performance of LF MRI technology compared to available 1.5 T MRI. RESULTS: A total of 1275 publications were retrieved from the selected databases. Only two articles meeting all predefined inclusion criteria were selected for detailed assessment. Conclusions: A limited number of robust studies on the accuracy and diagnostic performance of LF MRI compared with 1.5 T MRI was available. The current evidence is not sufficient to draw any definitive insights. More scientific research is needed to make informed conclusions regarding the effectiveness of LF MRI technology. [ABSTRACT FROM AUTHOR]

Extramammary Paget disease (EMPD) is an uncommon adenocarcinoma of apocrine gland-rich areas, presenting significant diagnostic challenges due to its nonspecific clinical appearance and frequent misidentification as benign, inflammatory skin conditions. Traditional diagnostic methods such as biopsy are invasive and uncomfortable, often required repeatedly due to high recurrence rates. Dermoscopy and non-invasive imaging techniques have been used but provide limited diagnostic accuracy due to their constraints in depth penetration and resolution. Recent advancements in imaging technologies, such as line-field confocal optical coherence tomography (LC-OCT), show promise in enhancing diagnostic precision while minimizing invasive procedures. LC-OCT merges high-resolution imaging with deep penetration capabilities, capturing detailed horizontal and vertical skin images akin to histopathology. This study evaluated the diagnostic performance of LC-OCT in detecting EMPD and its recurrence in 17 clinically suspicious anogenital regions, belonging to six patients. Data were collected prospectively at the patient's bedside by an LC-OCT expert with poor training for EMPD, and, then, reviewed retrospectively by an independent LC-OCT expert with adequate training for EMPD and no concerns about time. The prospective examination yielded 64.7% accuracy (11 true results out of 17 total cases), 71.4% sensitivity (10 true positives out of 14 actual positives), and 33.3% specificity (1 true negative out of 3 actual negatives). The retrospective analysis achieved 94.1% accuracy (16 true results out of 17 total cases), 100% sensitivity (14 true positives out of 14 actual positives), and 66.7% specificity (2 true positives out of 3 actual positives), with the only false positive case being a difficult-to-diagnose concomitant presentation of a lichen sclerosus et atrophicus. Despite the need for specialized training, our results suggest that LC-OCT represents a valuable tool for accurately identifying EMPD and improving its management by reducing unnecessary biopsies. Further studies are needed to standardize its clinical application. [ABSTRACT FROM AUTHOR]

Liquid biopsies have been identified as a viable source of cancer biomarkers. We aim to evaluate the diagnostic accuracy of cell-free DNA integrity (cfDI) in liquid biopsies for cancer. A comprehensive literature search was conducted through PubMed, Embase, Web of Science, and Cochrane Library up to June 2024. Seventy-two study units from forty-six studies, comprising 4286 cancer patients, were identified and evaluated. The Quality Assessment for Studies of Diagnostic Accuracy-2 (QUADAS-2) was used to assess study quality. Meta-regression analysis was employed to investigate the underlying factors contributing to heterogeneity, alongside an evaluation of publication bias. The bivariate random-effect model was utilized to compute the primary diagnostic outcomes and their corresponding 95% confidence intervals (CIs). The pooled sensitivity, specificity, and positive and negative likelihood ratios of cfDI in cancer diagnosis were 0.70 and 0.77, 3.26 and 0.34, respectively. The overall area under the curve was 0.84, with a diagnostic odds ratio of 10.63. This meta-analysis suggested that the cfDI index has a promising potential as a non-invasive and accurate diagnostic tool for cancer. Study registration: The study was registered at PROSPERO (reference No. CRD42021276290). [ABSTRACT FROM AUTHOR]

Background and purpose Methods Results Conclusion National quality registries for stroke care operate under the assumption that the included patients are correctly diagnosed. We aimed to validate the clinical diagnosis of spontaneous intracerebral hemorrhage (ICH) in Riksstroke (RS) by evaluating radiological data from a large, unselected ICH population.We conducted a retrospective, multicenter study including all ICH patients registered in RS between 2016 and 2020 residing in Skåne County in Sweden (1.41 million inhabitants). Radiological data from first imaging were evaluated for the presence of spontaneous ICH. Other types of bleeds were registered if a spontaneous ICH was not identified on imaging. The radiological evaluation was independently performed by one radiology fellow and one senior neuroradiologist.Between 2016 and 2020, 1784 ICH cases were registered in RS, of which 1655 (92.8%) had a radiological diagnosis consistent with spontaneous ICH. In the 129 (7.2%) remaining cases, the radiological diagnosis was instead traumatic bleed (n = 80), subarachnoid hemorrhage (n = 15), brain tumor bleed (n = 14), ischemic lesion with hemorrhagic transformation (n = 14), ischemic lesion (n = 3), or no bleed at all (n = 3). There was a higher degree of incorrect coding in the older age groups.At radiological evaluation, 92.8% of ICH diagnoses in RS were consistent with spontaneous ICH, yielding a high rate of agreement that strengthens the validity of the diagnostic accuracy in the register, justifying the use of high coverage quality register data for epidemiological purposes. The most common coding error was traumatic bleeds that were classified as spontaneous ICH. [ABSTRACT FROM AUTHOR]