Fecal screening tests in the approach to acute infectious diarrhea: a scientific overview
Huicho L, Campos M, Rivera J, Guerrant R L
Authors' objectives
To evaluate the value of faecal leukocyte, faecal occult blood, faecal lactoferrin, and a combination of faecal leukocytes
with clinical data in the workup of patients with inflammatory diarrhoea.
Searching
MEDLINE was searched from 1970 to September 1994 (the search terms were given). Additional relevant articles were
identified by consulting experts in the field, and by examining review articles and references in retrieved articles.
Study selection
Study designs of evaluations included in the review
All study designs reporting original data were eligible for inclusion. Technical articles which contained no clinical
information were excluded. Studies where diagnostic tests were performed without medical supervision were also
excluded.
Specific interventions included in the review
Articles including information on clinical data and/or faecal screening tests (faecal leukocytes, faecal occult blood,
faecal lactoferrin), assessed individually or in combination, were eligible for inclusion.
Reference standard test against which the new test was compared
The included studies were required to use stool culture in all patients as the reference standard. Diarrhoea was
considered inflammatory if the stool culture was positive for Salmonella, Shigella, Campylobacter, enteroinvasive E.
coli, enteropathogenic E. coli, or cytotoxigenic C. difficile.
Participants included in the review
Only articles relating to acute infectious diarrhoea in humans were eligible for inclusion.
Outcomes assessed in the review
The included articles were required to report sensitivity, specificity, and positive and negative predictive values, or to
provide sufficient data for the construction of a 2x2 contingency table.
How were decisions on the relevance of primary studies made?
All studies were reviewed independently by two reviewers who were not co-authors of the studies, using defined
inclusion criteria. A final decision was reached by consensus.
Assessment of study quality
The overall scientific quality of each study was rated on a 16-point scale (described in detail in the report), in which 16
represented a study with minimal flaws and 1 a study with extensive flaws. All studies were reviewed independently by
two reviewers who were not co-authors of the studies, using defined validity criteria. A final validity score was reached
by consensus.
Data extraction
The data were extracted independently by the two reviewers and any differences were resolved by consensus.
Methods of synthesis
How were the studies combined?
Database of Abstracts of Reviews of Effects (DARE)
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