This case of an asymptomatic woman in her 30s who presented for a baseline physical examination and was given nonrecomended liver function screening and phlebotomy following misdiagnosis highlights the importance of emphasizing clinical judgment in ordering and assesing test results.
This case of an otherwise healthy man in his 30s who presented to an optometrist with sudden-onset horizontal diplopia and blurry vision illustrates the importance of assessing the prior probability of an underlying disease before diagnostic testing is undertaken and considering how test results may influence treatment.
This study quantifies the notifications that physicians received via inboxes of commercial electronic health records to estimate their burden.
The case of a patient with gout described in this Teachable Moment demonstrates the importance of clinical reasoning and current care delivery systems when treating patients suspected of having crystal arthropathy.
This cohort study of hospitalized adults with suspected Clostridium difficile infection compared complications and deaths among those with positive vs negative polymerase chain reaction and toxin immunoassay test results.
In this secondary data analysis, Butt et al found that HCV+ persons have a more rapid progression of liver fibrosis and accelerated time to development compared with HCV− controls.
This study found that few drug labels contained or referenced convincing evidence of clinical utility of biomarker testing, whereas many made recommendations based on biomarker test results. See also the Invited Commentary by Burke.
The role of pneumococcal urinary antigen detection in the treatment of adults with community-acquired pneumonia (CAP) is not well defined. We assessed the usefulness of pneumococcal urinary antigen detection in the diagnosis and antimicrobial guidance in patients hospitalized with CAP.
A prospective study of all adults hospitalized with CAP was performed from February 2007 through January 2008. To evaluate the accuracy of the test, we calculated its sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. The gold standard used for diagnosis of pneumococcal pneumonia was isolation in blood or pleural fluid (definite diagnosis) and isolation in sputum (probable diagnosis). Antibiotic modifications, complications, and mortality were analyzed.
A total of 474 episodes of CAP were included. Streptococcus pneumoniae was the causative pathogen in 171 cases (36.1%). It was detected exclusively by urinary antigen test in 75 cases (43.8%). Sixty-nine patients had CAP caused by a pathogen other than S pneumoniae. Specificity was 96%, positive predictive value ranged from 88.8% to 96.5%, and the positive likelihood ratio ranged from 14.6 to 19.9. The results of the test led the clinicians to reduce the spectrum of antibiotics in 41 patients. Pneumonia was cured in all of them. Potentially, this optimization would be possible in the 75 patients diagnosed exclusively by the test.
When its findings are positive, the pneumococcal urinary antigen test is a useful tool in the treatment of hospitalized adult patients with CAP because it may allow the clinician to optimize antimicrobial therapy with good clinical outcomes.