Evaluation of Discordant Results Between FilmArray Meningitis/Encephalitis Panel and Conventional Testing in Pediatric Patients: A Multisite Retrospective Cohort Study.

BACKGROUND: The FilmArray Meningitis/Encephalitis panel (MEP) has an 11% false-positive and 2.2% false-negative rate compared with conventional testing. We describe clinical characteristics, treatment decisions, and outcomes in children with discordant results between MEP and conventional testing. METHODS: We conducted a multisite review of patients ≤ 18 years with suspected central nervous system infection and positive results by MEP or conventional testing (cerebrospinal fluid [CSF] culture, herpes simplex virus [HSV] polymerase chain reaction (PCR), and enterovirus [EV] PCR). Descriptive results are provided for patients with discordant results. Comparison between group 1 (MEP and CSF culture positive) and group 2 (MEP positive, CSF culture negative, or showing a different pathogen) was made by Mann-Whitney test for continuous and Fisher's test for categorical variables. RESULTS: A total of 355 patients had at least one pathogen identified. More than half of patients with bacterial pathogens identified that are included in the MEP had discordant results (30/52; 58%). There were 28 samples with bacterial pathogen identified on MEP only, 1 with different bacterial pathogens on MEP and culture, and 1 with Escherichia coli identified on CSF culture only. Patients in group 1 were more likely to have CSF pleocytosis, elevated CSF protein, and decreased CSF glucose than group 2 (P < .05). Two patients were HSV positive by MEP while HSV negative by PCR. Ten patients had discordant results between MEP and EV PCR. CONCLUSIONS: Discordant results between MEP and conventional testing are common. Treatment decisions based on a positive MEP should be made in the appropriate clinical context.

Assessing Residents' Competency at Baseline: How Much Does the Medical School Matter?

BACKGROUND: Although there is some consensus about the competencies needed to enter residency, the actual skills of graduating medical students may not meet expectations. In addition, little is known about the association between undergraduate medical education and clinical performance at entry into and during residency. OBJECTIVE: We explored the association between medical school of origin and clinical performance using a multi-station objective structured clinical examination for incoming residents at the University of Michigan Health System. METHODS: Prior to assuming clinical duties, all first-year residents at the University of Michigan Health System participate in the Postgraduate Orientation Assessment (POA). This assesses competencies needed during the first months of residency. Performance data for 1795 residents were collected between 2002 and 2012. We estimated POA variance by medical school using linear mixed models. RESULTS: Medical school predicted the following amounts of variance in performance-data gathering scores: 1.67% (95% confidence interval [CI] 0.36-2.93); assessment scores: 4.93% (95% CI 1.84-6.00); teamwork scores: 0.80% (95% CI 0.00-1.82); communication scores: 2.37% (95% CI 0.66-3.83); and overall POA scores: 4.19% (95% CI 1.59-5.35). CONCLUSIONS: The results show that residents' medical school of origin is weakly associated with clinical competency, highlighting a potential source of variability in undergraduate medical education. The practical significance of these findings needs further evaluation.