Evaluation of revised UK-NEQAS CSF-xanthochromia method for subarachnoid hemorrhage: outcome data provide evidence for clinical value.

IF 3.8 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Clinical chemistry and laboratory medicine Pub Date : 2024-10-30 DOI:10.1515/cclm-2024-0995
Khin Moe Sam, Hans G Schneider
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Abstract

Objectives: Subarachnoid haemorrhage (SAH) has a high morbidity and mortality and requires prompt diagnosis. In patients with negative findings on computed-tomogram of the brain (CT-Brain) cerebrospinal fluid (CSF)-xanthochromia is considered the test of choice if performed 12 h or more after symptom onset. We audited the accuracy, usefulness and timing of CSF-xanthochromia testing and the interpretation of equivocal CSF-xanthochromia findings. We also investigated mortality outcomes for defined subsets of patients.

Methods: A retrospective audit of CSF-xanthochromia tests over 8 years was performed. The service uses the revised UK-NEQAS (United Kingdom National External Quality Assessment Service) method.

Results: We analysed 543 cases (F=299, median age 44yrs) with 19 cases (3.5 %) having SAH. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CSF-xanthochromia testing were 100 , 98.1, 65.9, 100 % respectively (equivocal results were counted as positives). 280 cases (F=153, median age 43yrs) had LP performed more than 24 h after the onset of headache (median time to LP=72 h). The sensitivity and specificity of the CSF-xanthochromia were 100 and 97.4 % in this group with NPV 100 % and PPV 66.6 %. 183 (65.4 %) CSF- xanthochromia negative cases in this subgroup had follow up data and survived without SAH occurring in the 12 months follow up.

Conclusions: In this study, supported by follow up outcome data, we show that CSF-xanthochromia testing using the revised UK-NEQAS method is fit-for-purpose for the use as a second line test to exclude SAH in patients with negative CT-brain including delayed presentation more than 24 h after headache onset.

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评估蛛网膜下腔出血的英国-NEQAS CSF-黄染法修订版:结果数据为临床价值提供了证据。
目的:蛛网膜下腔出血(SAH)的发病率和死亡率都很高,需要及时诊断。对于脑电脑断层扫描(CT-Brain)结果为阴性的患者,如果在症状出现 12 小时或更长时间后进行脑脊液黄染检查,则被认为是首选检查方法。我们对脑脊液黄染试验的准确性、实用性和时间安排以及对不明确的脑脊液黄染结果的解释进行了审核。我们还调查了特定亚组患者的死亡率结果:我们对8年来的CSF-黄染试验进行了回顾性审计。该服务采用修订后的 UK-NEQAS(英国国家外部质量评估服务)方法:我们分析了 543 个病例(女=299,中位年龄 44 岁),其中 19 个病例(3.5%)患有 SAH。CSF-黄染检测的灵敏度、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为100%、98.1%、65.9%和100%(等效结果计为阳性)。280例患者(女=153,中位年龄43岁)在头痛发作24小时后进行了LP检查(LP检查的中位时间=72小时)。在这组病例中,CSF-黄染的敏感性和特异性分别为100%和97.4%,NPV为100%,PPV为66.6%。该亚组中有 183 例(65.4%)CSF-黄染阴性病例有随访数据,并且在 12 个月的随访中没有发生 SAH:在本研究中,我们通过随访结果数据证明,使用修订后的英国-NEQAS方法进行CSF-黄染试验,可作为二线试验,用于排除脑CT阴性患者的SAH,包括头痛发作24小时后延迟出现的患者。
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来源期刊
Clinical chemistry and laboratory medicine
Clinical chemistry and laboratory medicine 医学-医学实验技术
CiteScore
11.30
自引率
16.20%
发文量
306
审稿时长
3 months
期刊介绍: Clinical Chemistry and Laboratory Medicine (CCLM) publishes articles on novel teaching and training methods applicable to laboratory medicine. CCLM welcomes contributions on the progress in fundamental and applied research and cutting-edge clinical laboratory medicine. It is one of the leading journals in the field, with an impact factor over 3. CCLM is issued monthly, and it is published in print and electronically. CCLM is the official journal of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and publishes regularly EFLM recommendations and news. CCLM is the official journal of the National Societies from Austria (ÖGLMKC); Belgium (RBSLM); Germany (DGKL); Hungary (MLDT); Ireland (ACBI); Italy (SIBioC); Portugal (SPML); and Slovenia (SZKK); and it is affiliated to AACB (Australia) and SFBC (France). Topics: - clinical biochemistry - clinical genomics and molecular biology - clinical haematology and coagulation - clinical immunology and autoimmunity - clinical microbiology - drug monitoring and analysis - evaluation of diagnostic biomarkers - disease-oriented topics (cardiovascular disease, cancer diagnostics, diabetes) - new reagents, instrumentation and technologies - new methodologies - reference materials and methods - reference values and decision limits - quality and safety in laboratory medicine - translational laboratory medicine - clinical metrology Follow @cclm_degruyter on Twitter!
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