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blog:bpaddock:how_useful_is_glucose_detection_in_diagnosing_cerebrospinal_fluid_leak_the_rational_use_of_ct_and_beta-2_transferrin_assay_in_detection_of_cerebrospinal_fluid_fistula [2014/07/13 13:52]
bpaddock How useful is glucose detection in diagnosing cerebrospinal fluid leak?
blog:bpaddock:how_useful_is_glucose_detection_in_diagnosing_cerebrospinal_fluid_leak_the_rational_use_of_ct_and_beta-2_transferrin_assay_in_detection_of_cerebrospinal_fluid_fistula [2014/07/18 00:51] (current)
bpaddock Correted the spelling of 'and' that the original had as 'adn'.
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 METHODS: Fluid samples from the nose were collected from 18 patients with suspected CSF fistulae. The samples were assayed for beta-2 transferrin using the Western blotting and immunostaining technique. CT (5mm axial slice) of the skull base was performed for evidence of skull base fracture. The glucose levels and Glucostix results were compared. METHODS: Fluid samples from the nose were collected from 18 patients with suspected CSF fistulae. The samples were assayed for beta-2 transferrin using the Western blotting and immunostaining technique. CT (5mm axial slice) of the skull base was performed for evidence of skull base fracture. The glucose levels and Glucostix results were compared.
  
-RESULTS: Out of the 18 samples, 15 were positive for beta-2 transferrin ​adn the leaks were validated surgically in 10 patients. Give leaks healed spontaneously with conservative management. Glucostix tests produced three false positive results from blood and nasal mucus contaminated fluid. Glucostix failed to detect another three CSF leaks resulting from false negative tests because of low CSF glucose levels. The Glucostix glucose test was nonspecific and insensitive compared with the beta-2 transferrin assay. CT failed to detect three of the 15 beta-2 transferrin-positive leaks but there were no false positive results. CT produced six negative results, of which three were false negatives.+RESULTS: Out of the 18 samples, 15 were positive for beta-2 transferrin ​and the leaks were validated surgically in 10 patients. Give leaks healed spontaneously with conservative management. Glucostix tests produced three false positive results from blood and nasal mucus contaminated fluid. Glucostix failed to detect another three CSF leaks resulting from false negative tests because of low CSF glucose levels. The Glucostix glucose test was nonspecific and insensitive compared with the beta-2 transferrin assay. CT failed to detect three of the 15 beta-2 transferrin-positive leaks but there were no false positive results. CT produced six negative results, of which three were false negatives.
  
 CONCLUSIONS:​ Glucose detection using Glucostix test strips is not recommended as a confirmatory test due to its lack of specificity and sensitivity. In the presence of a skull bas fracture on CT and a clinical CSF leak, there is no need for a further confirmatory test. In cases where a confirmatory test is needed, the beta-2 transferrin assay is the test of choice because of its high sensitivity and specificity. CONCLUSIONS:​ Glucose detection using Glucostix test strips is not recommended as a confirmatory test due to its lack of specificity and sensitivity. In the presence of a skull bas fracture on CT and a clinical CSF leak, there is no need for a further confirmatory test. In cases where a confirmatory test is needed, the beta-2 transferrin assay is the test of choice because of its high sensitivity and specificity.