Table 4.
Sensitivity and specificity estimates for diagnosis of S. pneumoniae, N. meningitidis, or H. influenzae meningitis
|
Culture Standard |
CRSa |
LCA Modelb |
||||||
|---|---|---|---|---|---|---|---|---|
| Sens (%, 95CI) | Spec (%, 95CI) | Sens (%, 95CI) | Spec (%, 95CI) | Sens (%, 95CI) | Spec (%, 95CI) | |||
|
S. pneumoniae, N. meningitidis,orH. influenzae |
|
|
|
|
||||
| All patients, n=451 |
Culture |
na |
na |
na |
na |
81.3 (73.2-89.3) |
99.7 (99.1-100.0) |
|
| |
|
Gram stain |
97.5 (91.3-99.7) |
94.1 (91.2-96.3) |
na |
na |
98.2 (95.2-100.0) |
98.7 (97.3-100.0) |
| |
|
RT-PCR |
95.0 (87.7-98.6) |
90.0 (86.5-92.9) |
91.2 (83.9-95.9) |
94.3 (91.3-96.5) |
95.7 (91.2-100.0) |
94.3 (91.9-96.8) |
| Antibiotic negative, n=341 |
Culture |
na |
na |
na |
na |
85.7 (74.4-96.9) |
100.0 (99.8-100.0) |
|
| |
|
Gram stain |
100.0 (89.7-100.0) |
97.4 (94.9-98.9) |
na |
na |
98.7 (94.9-100.0) |
99.0 (97.9-100.0) |
| |
|
RT-PCR |
97.1 (84.7-99.9) |
96.1 (93.3-98.0) |
90.5 (77.4-97.3) |
97.7 (95.2-99.1) |
95.8 (89.1-100.0) |
97.7 (95.9-99.4) |
| Antibiotic positive, n=98 |
Culture |
na |
na |
na |
na |
78.2 (66.4-89.9) |
97.1 (91.9-100.0) |
|
| |
|
Gram stain |
97.7 (88.0-99.9) |
74.1 (60.4-85.0) |
na |
na |
99.5 (97.3-100.0) |
94.0 (84.1-100.0) |
| |
|
RT-PCR |
93.2 (81.3-98.6) |
55.6 (41.4-69.1) |
91.4 (81.0-97.1) |
70.0 (53.5-83.4) |
95.3 (89.0-100.0) |
70.2 (56.2-84.2) |
|
S. pneumoniaeonly |
|
|
|
|
|
|
||
| All patients, n=451 |
Culture |
na |
na |
na |
na |
85.3 (74.8-95.9) |
100.0 (99.9-100.0) |
|
| |
|
Gram stain |
97.5 (86.8-99.9) |
97.6 (95.6-98.8) |
na |
na |
96.4 (90.6-100.0) |
99.0 (98.1-100.0) |
| |
|
RT-PCR |
97.5 (86.8-99.9) |
97.1 (95.0-98.5) |
90.0 (78.2-96.7) |
98.5 (96.8-99.5) |
96.4 (90.6-100.0) |
98.6 (97.4-99.7) |
|
N. meningitidisonly |
|
|
|
|
|
|
||
| All patients, n=451 |
Culture |
na |
na |
na |
na |
77.9 (65.4-90.4) |
99.8 (99.3-100.0) |
|
| |
|
Gram stain |
97.2 (85.5-99.9) |
97.4 (95.3-98.7) |
na |
na |
98.7 (94.8-100.0) |
99.6 (98.9-100.0) |
| RT-PCR | 94.4 (81.3-99.3) | 94.5 (91.8-96.5) | 91.5 (79.6-97.6) | 96.5 (94.3-98.1) | 95.9 (89.3-100.0) | 96.6 (94.8-98.3) | ||
Performance parameters for the various tests are estimated using a CSF culture reference standard, composite reference standard (CRS), and latent class analysis (LCA) modeling with stratification by antimicrobial detection disk bioassay results.
Abbreviations: CRS, composite reference standard; LCA, latent class analysis; na, not applicable; 95% CI, 95% exact binomial confidence interval for culture reference standard and CRS parameters, or parameter estimate +/− 1.96 * standard error for LCA models.
aComposite reference standard defined as positive if CSF culture or Gram stain positive for S. pneumoniae, N. meningitidis, or H. influenzae.
bFor LCA model of all patients, disease prevalence was 21.5% (95% CI 17.7-25.4). For the model of antibiotic assay-negative patients, disease prevalence was 11.6% (95CI 8.2-15.0). For the model of antibiotic assay-positive patients, disease prevalence was 55.8% (96CI 45.4-66.1). For the model of S. pneumoniae diagnosis, disease prevelance was 10.4% (95CI 7.5-13.2). For the model of N. meningitidis diagnosis, disease prevalence was 10.0% (95CI 7.2-12.7). Bootstrap p for all models >0.1.