Beyond the complete blood cell count and C-reactive protein: a systematic review of modern diagnostic tests for XXXX .

@entity1 @entity650 @entity295 @entity2348 @entity281
OBJECTIVE: To systematically review the accuracy of modern laboratory tests for the diagnosis of serious @entity2348 in newborns. METHODS: The MEDLINE, EMBASE, and Cochrane Library databases were searched using the keywords newborn, @entity281 , @entity295 , and diagnosis. We included studies published from 1995 through 2001 that included @entity1 younger than 90 days with proven bacterial growth in a sample from a sterile site. Whenever possible, relevant data were extracted to calculate likelihood ratios (LRs) for whether each test can diagnose a serious @entity2348 . Two independent reviewers selected and reviewed the articles (interobserver agreement, kappa = 0.80). All disagreements were resolved by consensus. RESULTS: Of the 137 citations we retrieved, 37 articles met the inclusion criteria; 17 studies, evaluating 11 different tests, met the highest methodological criteria. The most commonly evaluated test was @entity650 ( @entity650 ) level (n = 7 studies). The remaining tests were each evaluated in no more than 3 studies. Positive LRs ranged from 1.5 to infinity. Six individual tests examined in 8 studies had LRs of more than 10 (range, 12.5- infinity ). Combined tests also had a wide range of LRs (3.4-9.9). All studies were performed in single medical centers and had small sample sizes, making recommendations according to gestational age criteria difficult. CONCLUSIONS: We found few methodologically rigorous studies of the accuracy of laboratory tests for the diagnosis of @entity2348 in newborns; in a significant proportion of studies, the accuracy of the tests could not be independently determined because of a lack of adequate data. There was marked heterogeneity in sample selection and cutoff levels for diagnosis of @entity295 . A few tests showed promising accuracy, but there are insufficient data to support their confident use as clinical tools.
