%0 Journal Article %J BMC Fam Pract %D 2010 %T Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs %A Giesen, Leonie G M %A Cousins, G %A Dimitrov, B %A Van de Laar, F A %A Fahey, T %K Adult %K Bayes Theorem %K Female %K Humans %K Predictive Value of Tests %K Urinalysis %K Urinary Tract Infections %X BACKGROUND: Acute urinary tract infections (UTI) are one of the most common bacterial infections among women presenting to primary care. However, there is a lack of consensus regarding the optimal reference standard threshold for diagnosing UTI. The objective of this systematic review is to determine the diagnostic accuracy of symptoms and signs in women presenting with suspected UTI, across three different reference standards (10(2) or 10(3) or 10(5) CFU/ml). We also examine the diagnostic value of individual symptoms and signs combined with dipstick test results in terms of clinical decision making. METHODS: Searches were performed through PubMed (1966 to April 2010), EMBASE (1973 to April 2010), Cochrane library (1973 to April 2010), Google scholar and reference checking.Studies that assessed the diagnostic accuracy of symptoms and signs of an uncomplicated UTI using a urine culture from a clean-catch or catherised urine specimen as the reference standard, with a reference standard of at least ≥ 10(2) CFU/ml were included. Synthesised data from a high quality systematic review were used regarding dipstick results. Studies were combined using a bivariate random effects model. RESULTS: Sixteen studies incorporating 3,711 patients are included. The weighted prior probability of UTI varies across diagnostic threshold, 65.1% at ≥ 10(2) CFU/ml; 55.4% at ≥ 10(3) CFU/ml and 44.8% at ≥ 10(2) CFU/ml ≥ 10(5) CFU/ml. Six symptoms are identified as useful diagnostic symptoms when a threshold of ≥ 10(2) CFU/ml is the reference standard. Presence of dysuria (+LR 1.30 95% CI 1.20-1.41), frequency (+LR 1.10 95% CI 1.04-1.16), hematuria (+LR 1.72 95%CI 1.30-2.27), nocturia (+LR 1.30 95% CI 1.08-1.56) and urgency (+LR 1.22 95% CI 1.11-1.34) all increase the probability of UTI. The presence of vaginal discharge (+LR 0.65 95% CI 0.51-0.83) decreases the probability of UTI. Presence of hematuria has the highest diagnostic utility, raising the post-test probability of UTI to 75.8% at ≥ 10(2) CFU/ml and 67.4% at ≥ 10(3) CFU/ml. Probability of UTI increases to 93.3% and 90.1% at ≥ 10(2) CFU/ml and ≥ 10(3) CFU/ml respectively when presence of hematuria is combined with a positive dipstick result for nitrites. Subgroup analysis shows improved diagnostic accuracy using lower reference standards ≥ 10(2) CFU/ml and ≥ 10(3) CFU/ml. CONCLUSIONS: Individual symptoms and signs have a modest ability to raise the pretest-risk of UTI. Diagnostic accuracy improves considerably when combined with dipstick tests particularly tests for nitrites. %B BMC Fam Pract %V 11 %P 78 %8 2010 %G eng %U http://www.biomedcentral.com/1471-2296/11/78 %R 10.1186/1471-2296-11-78 %0 Journal Article %J Br J Cancer %D 2010 %T Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer %A Olde Bekkink, M %A McCowan, Colin %A Falk, G %A Teljeur, C %A Van de Laar, F A %A Fahey, T %K Adenocarcinoma %K Adult %K Aged %K Anemia %K Barium Sulfate %K Cohort Studies %K Colonoscopy %K Colorectal Neoplasms %K Enema %K Family Practice %K Female %K Gastrointestinal Hemorrhage %K Humans %K Male %K Middle Aged %K Pain %K Primary Health Care %K Prospective Studies %K Rectum %K Reference Standards %K Risk %K Sensitivity and Specificity %K Sigmoidoscopy %K Weight Loss %X BACKGROUND: Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in patients with rectal bleeding in relation to risk of colorectal cancer in primary care. METHODS: Diagnostic accuracy systematic review. Medline (1966 to May 2009), Embase (1988 to May 2009), British Nursing Index (1991 to May 2009) and PsychINFO (1970 to May 2009) were searched. We included cohort studies that assessed the diagnostic utility of rectal bleeding in combination with other symptoms, signs and diagnostic tests in primary care. An eight-point quality assessment tool was produced to assess the quality of included studies. Pooled positive likelihood ratios (PLRs), sensitivities and specificities were calculated. RESULTS: Eight studies incorporating 2323 patients were included. Average weighted prior probability of colorectal cancer was 7.0% (range: 3.3-15.4%, median: 8.1%). Age > or = 60 years (pooled PLR: 2.79, 95% confidence interval (CI) 2.00-3.90), weight loss (pooled PLR: 1.89, 95% CI: 1.03-3.07) and change in bowel habit (pooled PLR: 1.92, 95% CI: 0.54-3.57) raise the probability of colorectal cancer into the range of referral to secondary care but do not conclusively 'rule in' the diagnosis. Presence of severe anaemia has the highest diagnostic value (pooled PLR: 3.67, 95% CI: 1.30-10.35), specificity 0.95 (95% CI: 0.93-0.96), but still only generates a post-test probability of 21.6%. CONCLUSIONS: In patients with rectal bleeding who present to their general practitioner, additional 'red flag' symptoms have modest diagnostic value. These findings have implications in relation to recommendations contained in clinical practice guidelines. %B Br J Cancer %V 102 %P 48-58 %8 2010 Jan 5 %G eng %U http://www.nature.com/bjc/journal/v102/n1/full/6605426a.html %N 1 %R 10.1038/sj.bjc.6605426 %0 Journal Article %J Headache %D 2011 %T Diagnostic accuracy of the ID Migraine: a systematic review and meta-analysis %A Cousins, G %A Hijazze, Samira %A Van de Laar, F A %A Fahey, T %K Humans %K Migraine Disorders %K Predictive Value of Tests %K Reproducibility of Results %K Sensitivity and Specificity %X OBJECTIVE: The purpose of this systematic review with meta-analysis is to determine the diagnostic accuracy of the identification of migraine (ID Migraine) as a decision rule for identifying patients with migraine. BACKGROUND: The ID Migraine screening tool is designed to identify patients with migraine in primary care settings. Several studies have validated the ID Migraine across various clinical settings, including primary care, neurology departments, headache clinics, dental clinics, ear, nose, and throat (ENT) and ophthalmology. METHODS: A systematic literature search was conducted to identify all studies validating the ID Migraine, with the International Headache Criteria as the reference standard. The methodological quality of selected studies was assessed using the Quality of Diagnostic Accuracy Studies tool. All selected studies were combined using a bivariate random effects model. A sensitivity analysis was also conducted, pooling only those studies using representative patient groups (primary care, neurology departments, and headache clinics) to determine the potential influence of spectrum bias on the results. RESULTS: Thirteen studies incorporating 5866 patients are included. The weighted prior probability of migraine across the 13 studies is 59%. The ID Migraine is shown to be useful for ruling out rather than ruling in migraine, with a greater pooled sensitivity estimate (0.84, 95% confidence interval 0.75-0.90) than specificity (0.76, 95% confidence interval 0.69-0.83). A negative ID Migraine score reduces the probability of migraine from 59% to 23%. The sensitivity analysis reveals similar results. CONCLUSIONS: This systematic review quantifies the diagnostic accuracy of the ID Migraine as a brief, practical, and easy to use diagnostic tool for Migraine. Application of the ID Migraine as a diagnostic tool is likely to improve appropriate diagnosis and management of migraine sufferers. %B Headache %V 51 %P 1140-8 %8 2011 Jul-Aug %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2011.01916.x/abstract;jsessionid=D4B74FF3BAD1073878D910966C56835A.f03t04 %N 7 %R 10.1111/j.1526-4610.2011.01916.x %0 Generic %D 2010 %T Systematic review on the diagnostic accuracy of signs and symptoms predicting UTI in women. 13th Annual Scientific Meeting of the Association of University Departments of General Practice in Ireland, 19 March 2010, RCSI, Dublin, Ireland %A Giesen, Leonie G M %A Cousins, G %A Dimitrov, B %A Van de Laar, F A %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/GiesenL/GC_LG_AUDGPI_presentation_final.ppt %0 Generic %D 2009 %T Predictive value of symptoms, signs and diagnostic tests in patients presenting with rectal bleeding in primary care: diagnostic accuracy systematic review in relation to colorectal cancer. 12th ASM, AUDGPI, 27th February 2009, RCSI, Dublin %A Olde Bekkink, M %A McCowan, Colin %A Falk, G %A Van de Laar, F A %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/OldeBekkinkM/AUDGPI%2027Feb09_Syst%20rev_colorectal%20cancer_M.OldeBekkink.ppt %0 Generic %D 2009 %T Predictive value of symptoms, signs and diagnostic tests in patients presenting with rectal bleeding in primary care: diagnostic accuracy systematic review in relation to colorectal cancer. SAPC Conference, 8-10 July 2009, University of Dundee, UK %A Olde Bekkink, M %A McCowan, Colin %A Falk, G %A Van de Laar, F A %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/OldeBekkinkM/SAPC%2008July09_Parallel%20session%20Cancer_Abstract%20nr%201430_Syst%20review%20colorectal%20cancer.ppt %0 Generic %D 2011 %T Predicting recurrence free survival after radical prostatectomy: A systematic review of the validation of the CAPRA Clinical prediction rule. SAPC 2011 Conference 2011. 6 - 8 July 2011, Bristol, UK %A Galvin, R %A Meurs, Pieter %A Van de Laar, F A %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/B15%20Meurs.ppt %0 Generic %D 2011 %T Diagnostic accuracy of the ID-Migraine: a systematic review and meta-analysis. SAPC 2011 conference 2011 6 - 8 July 2011, Bristol, UK %A Cousins, G %A Hijazze, Samira %A Van de Laar, F A %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/A41%20Cousins.ppt