Faculty Bibliography

PROBLEM: To assess the usefulness of amniotic fluid (AF) granulocyte colony-stimulating factor levels (G-CSF) in chorioamnionitis (CAM) to predict neonatal sepsis. METHOD OF STUDY: AF samples were obtained from term and preterm patients with (Group I) and without (Group II) CAM and were assayed for G-CSF levels. Patients with other infections were excluded. All AF samples were also tested for gram stain and cultures. The sensitivity, specificity, and predictive values of these parameters for diagnosing neonatal sepsis were assessed. RESULTS: Positive AF cultures were the best predictors of neonatal sepsis in CAM, with a sensitivity of 67% and a positive predictive value (PPV) of 80%. Elevated AF G-CSF levels (> 1,000 pg/ml) were poor predictors of neonatal sepsis with a sensitivity of 29% and PPV of 39%. CONCLUSION: Even though AF G-CSF levels were markedly elevated in patients with CAM, they were poor predictors of subsequent neonatal sepsis

PROBLEM: To assess the usefulness of amniotic fluid (AF) granulocyte colony stimulating factor (G-CSF) levels as a rapid marker for diagnosing chorioamnionitis. METHOD OF STUDY: AF levels were obtained from term and preterm patients with and without chorioamnionitis (CAM). Patients with urinary tract, respiratory tract, and other infections were excluded. Results obtained from the AF G-CSF assays were compared with those from other parameters used for diagnosing CAM: maternal fever, leukocytosis, tachycardia, fetal tachycardia, AF glucose levels, white blood cell count, Gram stain, and aerobic and anaerobic cultures. The sensitivity, specificity, and predictive values were calculated. RESULTS: In the uninfected AF samples, G-CSF levels were present but low, ranging from 400 to 1600 pg/ml. Levels in the infected samples, however, were markedly increased, ranging from 1600 to 14,000 pg/ml; P < 0.05. When a cutoff of 2000 pg/ml was used as a clear marker for CAM, the sensitivity was 67%, the specificity was 100%, and the positive and negative predictive values were 100% and 86%, respectively. The comparison of the other AF G-CSF laboratory parameters also revealed high sensitivity, specificity, and predictive values for detecting CAM. CONCLUSION: (i) AF G-CSF levels are elevated in CAM. (ii) An AF G-CSF level > 2000 pg/ ml is a strong positive predictor of CAM. (iii) Elevated AF G-CSF levels appear to be more reliable in predicting CAM than any other single test currently used in clinical practice

OBJECTIVE: To assess the treatment of continuous data in a sample of obstetric and gynecologic literature. METHODS: We reviewed articles in Obstetrics and Gynecology published in the first 4 months of 1985 and 1995. Data were tabulated on a data form created specifically for this purpose and reviewed for accuracy. RESULTS: The sample set included 170 variables in 102 original articles from Obstetrics and Gynecology published from January to April 1995, inclusive (group A, contemporary articles), and 117 variables in 89 articles published between January and April 1985, inclusive (group B, historic articles). Fifty-three variables (31% of total variables) in group A and 27 variables (23% of total variables) in group B (chi 2, P = .05) were continuous predictor variables. The historic-period articles (63%) were significantly more likely to represent continuous data only as categoric variables than were articles in the contemporary period (38%) (Fisher exact test, P = .037). Correlation coefficients, r values, were provided where possible in ten articles in the contemporary period (83%) and four articles in the historic period (31%) (Fisher exact test, P = .008). In articles in which continuous predictors were treated only as categoric variables, an emphasis was placed on the findings based only on categories in four of 12 (33%) of these articles in 1995 and nine of 13 (69%) in 1985 (Fisher exact test, P = .05). CONCLUSIONS: The treatment of continuous data has improved over the time period reviewed. However, clinicians should be aware that continuous data may be mischaracterized as categoric variables in some journal articles. We hope that in the future, editors will consider requesting r values for all continuous data relations. The quality-of-care implications of using discrete cutoffs of continuous data for patient care should be investigated