ABSTRACT
INTRODUCTION: Preoperative diagnosis of periprosthetic shoulder infections (PSI) is difficult. Infections are mostly caused by low virulence bacteria and patients do not show typical signs of infection. The aim of this study was to determine the diagnostic value and reliability of ultrasound-guided biopsies for cultures alone and in combination with multiplex polymerase chain reaction (mPCR), serum markers, and/or synovial markers for the preoperative diagnosis of PSI in patients undergoing revision shoulder surgery. MATERIALS AND METHODS: A prospective explorative diagnostic cohort study was performed including 55 patients undergoing revision shoulder replacement surgery. A shoulder puncture was performed preoperatively before incision to collect synovial fluid for mPCR analysis and for measurement of interleukin-6, calprotectin, white blood cell count (WBC), and polymorphonuclear cells. Also prior to revision surgery, six ultrasound-guided synovial tissue biopsies were collected for culture and two for mPCR analysis. A blood sample was obtained to determine serum C-reactive protein, WBC, and erythrocyte sedimentation rate. Six routine care tissue biopsies were taken during revision surgery and served as reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV; the primary outcome measure), and accuracy were calculated for ultrasound-guided biopsies, blood and synovial markers, mPCR, and combinations thereof. RESULTS: Routine tissue cultures were positive for infection in 24 patients. Cultures from ultrasound-guided biopsies diagnosed infection in 7 of these patients, yielding a sensitivity, specificity, PPV, NPV, and accuracy of 29.2%, 93.5%, 77.8%, 63.0%, and 65.6%, respectively. The best diagnostic value was found for the combination of ultrasound-guided biopsies for culture, synovial WBC, and calprotectin with a sensitivity of 69.2%, specificity of 80.0%, PPV of 69.2%, and NPV of 80.0%. CONCLUSION: Ultrasound-guided biopsies for cultures alone and in combination with mPCR, and/or blood and/or synovial markers are not reliable enough to use in clinical practice for the preoperative diagnosis of PSI. LEVEL OF EVIDENCE: Diagnostic study level II.
ABSTRACT
OBJECTIVES: A nationwide confidential enquiry into maternal deaths was carried out in Surinam during the years 1991-1993. Preliminary analysis showed a maternal mortality ratio (MMR) of 240 per 100000 live births, which was almost four times higher than the official MMR for the preceding decade. The question arose whether maternal deaths had been under-reported for the years 1981-1990. For these 10 years official statistics revealed 65 maternal deaths. METHODS: For the period 1981-1990 a retrospective reproductive age mortality survey was carried out in five urban hospitals covering 78% of all deliveries in Surinam. RESULTS: In these hospitals 1216 women of age 10-49 years died. Due to disorganized filing 439 medical records (36%) could not be traced. By reviewing 64% of the records, 85 maternal deaths were identified (70 direct and 15 indirect). CONCLUSION: Although only 64% of medical records could be reviewed, the number of maternal deaths identified in five hospitals (85) was 1.3 times higher than the officially reported number for the whole country (65). Maternal mortality was found therefore to be under-reported in Surinam for the period 1981-1990.
PIP: This study investigates the reliability of the maternal mortality ratio reported officially by hospitals in Surinam during 1981-90. A survey on retrospective reproductive age mortality was carried out in five urban hospitals in Surinam. Within the study period, the total number of live births in 5 hospitals was 82,512. In these hospitals, 85 cases of maternal death were identified, which is 1.3 times higher than the 65 cases of maternal death officially reported to the Ministry of Health. But this hospital ratio does not reflect the national ratio because of the following reasons: 1) the number of maternal death occurring outside the hospitals remains unknown; 2) only 64% of the records of women dying during the reproductive age in urban hospitals were studied. Thus under-reporting of maternal mortality in the Surinam national register for the period 1981-90 is likely to reflect a worse scenario than the officially reported number of cases. This study indicates that there is a need to improve the quality of registration of maternal deaths in Surinam.
