Understanding Negative Predictive Value of Diagnostic Tests Used in Clinical Practice

Umberger, Reba; Hatfield, Linda; Speck, Patricia M.

doi:10.1097/dcc.0000000000000219

Cited by 22 publications

(16 citation statements)

References 21 publications

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“…Cxbladder had an improved NPV compared with urine cytology, which, when coupled with high sensitivity, provides reliable rule out of patients without UC. Rule-out tests with high sensitivity combined with a high NPV provide better clinical resolution for ruling out patients who have a low probability of disease [19,20] than tests with only a high NPV. These findings support previous published results, which have shown that all Cxbladder tests significantly outperformed urine cytology for identifying patients without UC [14-[ 5 _ T D $ D I F F ] 16,23].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Cxbladder and Adjudication of Atypical Cytology and Equivocal Cystoscopy

et al. 2019

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Background: Cxbladder diagnostic tests combine genomic information from urinary mRNA with phenotypic information to either rule out low-risk individuals or identify patients at a high risk of urothelial carcinoma (UC). Objective: To evaluate the performance of Cxbladder and urine cytology, and Cxbladder's adjudication of atypical cytology and equivocal cystoscopy. Design, setting, and participants: This is a retrospective analysis of pooled data from three prospective Cxbladder clinical trials and one real-world clinical study. Physicians were blinded to Cxbladder results, and Cxbladder providers were blinded to clinical results. This study analyzed diverse urology practices in the USA, Australia, and New Zealand. A total of 1784 consecutive, prospectively recruited patients with hematuria or previously diagnosed UC provided 852 samples with both local cytology and Cxbladder results; 153 had atypical cytologies and 14 had both atypical cytology and equivocal cystoscopy. Outcome measurements and statistical analysis: Negative predictive value (NPV) and proportion of tumors missed for Cxbladder and local cytology, and evaluation of Cxbladder for adjudicating atypical cytology and equivocal cystoscopy. Results and limitations: Cxbladder ruled out 35% of patients and NPV 97% (95% confidence interval [CI] 94-98%) compared with 93% (95% CI 91-94%) for cytology; Cxbladder missed 8.5% and cytology missed 63% of tumors. UC was diagnosed in 26/153 cases of atypical cytology (17%). Cxbladder correctly adjudicated all these patients including those with both atypical cytology and equivocal cystoscopy; these patients had a positive Cxbladder result and were diagnosed with UC by pathology. The incidence of patients with both atypical cytology and equivocal cystoscopy is low. Conclusions: Cxbladder correctly adjudicated all patients diagnosed with UC among those with atypical cytology and equivocal cystoscopy, and outperformed cytology for accurately identifying patients who do not have UC. Patient summary: Cxbladder accurately rules out patients who do not have cancer, and adjudicates cytology and cystoscopy with inconclusive results, minimizing the need for patients to undergo further unnecessary tests and procedures.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Cxbladder and Adjudication of Atypical Cytology and Equivocal Cystoscopy

et al. 2019

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“…Overall, our risk prediction model had very good discrimination and calibration and a high negative predictive value using the optimal cut-off of ≥15%. Similar to most clinical prediction rules, where a better negative predictive value is of higher utility than the positive predictive value, 15 the risk to a patient from incorrectly classifying them as not needing urgent dialysis when they do (false negative) is far greater than the risk to them if they are incorrectly classified as needing urgent dialysis when they do not (false positive). With our model, a predicted probability of <15% means there is only a 7% chance the patient will require urgent dialysis.…”

Section: Discussionmentioning

confidence: 99%

Optimizing Ambulance Transport of Hemodialysis Patients to the Emergency Department: A Cohort Study

Vinson

Bartolacci

Goldstein

et al. 2019

Can J Kidney Health Dis

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Background: Dialysis patients who require ambulance transport to the emergency department (“ambulance-ED”) may subsequently require timely dialysis in a monitored setting (“urgent dialysis”). Objective: The purpose of this study was to develop and internally validate a risk prediction model for urgent dialysis based on patient characteristics at the time of paramedic assessment before ambulance-ED. Design: Cohort Study Setting: Region of Nova Scotia, Canada, covered by a single emergency medical services provider Patients: Thrice-weekly hemodialysis patients who initiated dialysis between 2009 and 2013 (follow-up to 2015) and experienced one or more ambulance-ED events. Measurements: The primary outcome (“urgent dialysis”) was defined as dialysis within 24 hours of an ambulance-ED in a monitored setting or dialysis within 24 hours of an ambulance-ED with an initial ED potassium of >6.5 mmol/L. Predictors of urgent dialysis based on paramedic assessment before ambulance-ED included presenting complaint, vital signs and time from last dialysis to ambulance dispatch. Methods: Associations with urgent dialysis were analyzed using logistic regression from which a risk prediction model was created. The model was internally validated using bootstrapping and model performance was assessed by discrimination and calibration. Results: Among 197 patients, there were 624 ambulance-ED events and 87 episodes of urgent dialysis. Weakness as a presenting complaint (odds ratio [OR]: 4.62, 95% confidence interval [CI]: 1.23-17.29), >24 hours since last dialysis (OR: 2.09, 95% CI: 1.15-3.81), and vital signs, including heart rate <60 beats/minute (OR: 3.06, 95% CI: 1.09-8.61), oxygen saturation <90% (OR: 3.04, 95% CI: 1.55-5.94), elevated respiratory rate (≥20 breaths/min), and systolic blood pressure>160 mmHg, were associated with urgent dialysis after ambulance-ED. A risk prediction model incorporating these variables had very good discrimination (C-statistic: 0.81, 95% CI: 0.76-0.86). The negative predictive value was 93.6% using the optimal cut point. Of patients who were predicted to need urgent dialysis but were transported to a facility incapable of providing it, 31% were re-transported for urgent dialysis. Limitations: Findings of our study may not be generalizable to other centers where the practice of ambulance transfer and availability of monitored dialysis may differ, and data were lacking for potential missed dialysis sessions or changes in routine dialysis scheduling. Conclusions: Patient characteristics at the time of paramedic assessment are associated with urgent dialysis after ambulance-ED. This risk prediction model has the potential to guide dialysis patient transport to dialysis-capable facilities when needed.

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“…These results suggest that even early EAC cancers, elective parotidectomy should be considered if the tumor location is a‐EAC and/or c‐EAC. Given the importance of high sensitivity and negative predictive value in a diagnostic setting, 23 our results can be applied for clinical decision making and to determine elective parotidectomy according to tumor location.…”

Section: Discussionmentioning

confidence: 99%

Occult parotid involvement in early‐stage squamous cell carcinoma of the external auditory canal

Chang

Lee

et al. 2021

Head & Neck

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Background The importance of elective parotidectomy in early‐stage squamous cell carcinoma (SCC) of the external auditory canal (EAC) is not well established. Methods A retrospective study of 43 patients with early‐stage SCC of the EAC who underwent parotidectomy in conjunction with lateral temporal bone resection at three centers. Results Overall occult parotid involvement (OPI) rate in early‐stage SCC of the EAC was 13.9% (6/43). When considering both the anteroposterior position and the bony‐cartilaginous position, patients with SCC in both the anterior wall and cartilaginous portion exhibited significantly higher OPI than other locations (37.5% vs. 0%, p = 0.001), with an increase in the OPI predictive value. Conclusion SCC located in either the anterior wall of the EAC or the cartilaginous portion of the EAC or both simultaneously showed a high prevalence of OPI, and elective parotidectomy should be considered in those patients.

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Understanding Negative Predictive Value of Diagnostic Tests Used in Clinical Practice

Cited by 22 publications

References 21 publications

Evaluation of Cxbladder and Adjudication of Atypical Cytology and Equivocal Cystoscopy

Evaluation of Cxbladder and Adjudication of Atypical Cytology and Equivocal Cystoscopy

Optimizing Ambulance Transport of Hemodialysis Patients to the Emergency Department: A Cohort Study

Occult parotid involvement in early‐stage squamous cell carcinoma of the external auditory canal

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