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Effective patient selection for PCD diagnostics; the PICADAR score with nasal nitric oxide

Samuel Collins, Laura Behan, Kerry Gove, Amanda-Lea Harris, Jane Lucas
European Respiratory Journal 2016 48: PA3124; DOI: 10.1183/13993003.congress-2016.PA3124
Samuel Collins
1Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
2Clinical and Experimental Sciences Academic Unit, University of Southampton, Southampton, United Kingdom
3NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Laura Behan
1Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
2Clinical and Experimental Sciences Academic Unit, University of Southampton, Southampton, United Kingdom
3NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Kerry Gove
1Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
3NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Amanda-Lea Harris
2Clinical and Experimental Sciences Academic Unit, University of Southampton, Southampton, United Kingdom
3NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Jane Lucas
1Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
2Clinical and Experimental Sciences Academic Unit, University of Southampton, Southampton, United Kingdom
3NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Abstract

Primary ciliary dyskinesia (PCD) symptoms are non-specific and tools to aid patient selection for referral are needed.

Objectives: To assess accuracy of a validated symptom score (PICADAR) [Behan, ERJ, 2016], in combination with nasal nitric oxide (nNO) to identify patients needing full diagnostics.

Methods: Prospective data from 142 consecutive referrals for PCD diagnostics (33 PCD positive, 111 negative). Sensitivity/specifity calculated using either PICADAR score >5 or nNO below threshold (30, 77 or 100nl/min) as a positive test compared to final diagnosis of PCD.

Results: PICADAR alone had sensitivity 0.88 and specificity 0.95. nNO+PICADAR improved identification of PCD positive patients. Accuracy was dependent on nNO threshold; sensitivities/specificities were 0.94/0.89, 0.94/0.78 and 1.0/0.73 using 30, 77 and 100nl/min.

Accuracy of single test (nNO or PICADAR)Accuracy of simultaneous testing (nNO or PICADAR positive)
nNO (30nl/min)nNo (77nl/min)nNo (100nl/min)PICADARnNO (30nl/min) + PICADARnNO (77nl/min) + PICADARnNO (100nl/min) + PICADAR
True pos30313329313133
True neg1059181105998678
False pos620306122533
False neg3204220
Sens.(95% CI)0.91 (0.76-0.98)0.94 (0.80-0.99)1.00 (0.89-1.00)0.88 (0.72-0.97)0.94 (0.80-0.99)0.94 (0.80-0.99)1.00 (0.89-1.0)
Spec.(95% CI)0.95 (0.89-0.98)0.82 (0.74-0.89)0.73 (0.64-0.81)0.95 (0.89-0.98)0.89 (0.82-0.94)0.78 (0.69-0.85)0.70 (0.60-0.79)

Accuracy of individual/combination testing using PICADAR and nasal nitric oxide (nNO)

Conclusion: PICADAR effectively selects patients for referral to PCD diagnostics but some cases are missed. Addition of nNO provides a highly sensitive patient selection; 100nl/min nNO threshold gives a sensitivity and negative predictive value of 100%.

  • Epidemiology
  • Nitric oxide
  • Copyright ©the authors 2016
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Effective patient selection for PCD diagnostics; the PICADAR score with nasal nitric oxide
Samuel Collins, Laura Behan, Kerry Gove, Amanda-Lea Harris, Jane Lucas
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3124; DOI: 10.1183/13993003.congress-2016.PA3124

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Effective patient selection for PCD diagnostics; the PICADAR score with nasal nitric oxide
Samuel Collins, Laura Behan, Kerry Gove, Amanda-Lea Harris, Jane Lucas
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3124; DOI: 10.1183/13993003.congress-2016.PA3124
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