Modalities and accuracy of diagnosis of external ventricular drainage-related infections: a prospective multicentre observational cohort study.

BACKGROUND: Device infection is a major complication of placement external ventricular drains (EVD). Diagnostic features are often masked by underlying disease or cerebrospinal fluid (CSF) contamination by blood. We aim to assess which diagnostic modalities are applied for EVD-related infection (ERI) diagnosis and evaluate their accuracy. METHODS: This observational prospective study included 187 adult patients with an EVD. Modalities of clinical diagnosis of ERI diagnosed by treating physicians on clinical grounds and blood and CSF analysis (clinically diagnosed ERI (CD-ERI)) were assessed prospectively. Additionally, the diagnostic accuracy of clinical and laboratory parameters for the diagnosis of culture proven ERI (CP-ERI) was evaluated, using data of the study patients and including a retrospective cohort of 39 patients with CP-ERI. RESULTS: Thirty-one CD-ERIs were diagnosed in the prospective cohort. Most physicians used CSF analysis to establish the diagnosis. ROC analysis revealed an AUC of 0.575 (p = 0.0047) for the number of positive SIRS criteria and AUC of 0.5420 (p = 0.11) for the number of pathological neurological signs for diagnosis of CP-ERI. Diagnostic accuracy of laboratory values was AUC 0.596 (p = 0.0006) for serum white blood cell count (WBCC), AUC 0.550 (p = 0.2489) for serum C-reactive protein, AUC 0.644 (p < 0.0001) for CSF WBCC and AUC 0.690 for CSF WBC/red blood cell count ratio (both p < 0.0001). Neither a temporal trend in potential predictors of CP-ERI nor a correlation between clinical diagnosis and proven CSF infection was found. CONCLUSIONS: Clinicians base their diagnosis of ERI mostly on CSF analysis and occurrence of fever, leading to over-diagnosis. The accuracy of the clinical diagnosis is low. Commonly used clinical and laboratory diagnostic criteria have a low sensitivity and specificity for ERI.

Life stress and athletic injury: examination of positive versus negative events and three moderator variables.

A modified version of the Life Experiences Survey (LES) was used to examine the relationship between positive and negative life change and subsequent athletic injury among 104 collegiate varsity football players drawn from two teams. The findings from Team One indicated that players who incurred a significant time-loss injury had experienced greater negative--but not positive--life changes in the previous twelve months than noninjured players. Further, injured players tended to have higher object loss scores than noninjured players. No between-group differences were found for Team Two. Trait anxiety, competitive trait anxiety, and locus of control were examined as possible moderator variables in the life change--injury relationship, and were found to have no significant effects. While partially supporting past research, the findings indicate that more work on the stress--injury relationship is needed before life change measures can contribute to the assessment of athletes' injury potential.

Factors related to competitive stress among male youth sport participants.

A study was conducted to determine intrapersonal and situational factors related to the stress experienced by 11 and 12 year old boys participating in competitive youth sports. Potential stress related factors were assessed at preseason, pregame, and postgame periods. The indicant of stress was state anxiety measured by the Spielberger State Anxiety Inventory for Children administered 30 minutes prior to and immediately following a competitive soccer game. Findings indicated that competitive trait anxiety, self esteem, basal state anxiety, and expectancies of self and team performance outcomes were significantly related to stress experienced when anticipating competition. As hypothesized, game win-loss was a highly significant predictor of post-game stress. Other predictors of postgame stress were the game win-loss x game closeness interaction, the amount of fun experienced during the game, basal state anxiety, and the perceived importance of a game win to the coach. The findings are discussed in terms of the child's actual and perceived response capabilities in meeting the performance demands of the highly evaluative sport competition process.