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Table 2 Comparison of the diagnostic evaluation parameters for direct KOH examination, culture, and biopsy according to the methodological quality of the studies

From: Meta-analysis of the utility of culture, biopsy, and direct KOH examination for the diagnosis of onychomycosis

  KOH (95% CI) Culture (95% CI) Biopsy (95% CI)
Positive subjects: True Positives/False Negatives
 Total 857/545 966/745 1,483/288
 High quality 677/453 684/448 975/236
 Average quality 180/92 282/297 508/52
Negative subjects: True Negatives/False Positives
 Total 690/33 808/6 881/105
 High quality 622/28 643/5 709/92
 Average quality 68/5 165/1 172/13
Sensitivity
 Total 61 (59–64) 56 (54–59) 84 (82–86)
 High quality 60 (57–63) 60 (58–63) 81 (78–83)
 Average quality 66 (60–72) 49 (45–53) 91 (88–93)
Specificity
 Total 95 (94–97) 99 (98–100) 89 (87–91)
 High quality 96 (94–97) 99 (98–100) 89 (86–91)
 Average quality 93 (85–98) 99 (97–100) 93 (88–96)
Positive likelihood ratio
 Total 9.6 (1.0–95.1) 17.3 (6.1–48.8) 7.2 (2.8–18.9)
 High quality 8.5 (0.3–255.7) 17.7 (3.4–91.8) 4.4 (1.4–13.8)
 Average quality 9.6 (1.8–51.9) 16.6 (5.4–50.8) 24.3 (0.9–631.9)
Negative likelihood ratio
 Total 0.4 (0.3–0.5) 0.45 (0.4–0.5) 0.2 (0.1–0.3)
 High quality 0.4 (0.3–0.5) 0.4 (0.3–0.5) 0.3 (0.2–0.4)
 Average quality 0.4 (0.2–0.6) 0.5 (0.4–0.7) 0.1 (0.0–0.21)
Diagnostic OR
 Total 27.0 (9.8–73.9) 44.7 (17.9–111.5) 44.6 (13.0–153.5)
 High quality 28.0 (7.4–106.3) 53.9 (12.7–229.1) 16.4 (4.2–64.8)
 Average quality 25.5 (4.4–159.7) 32.3 (10.0–104.3) 249.1 (75.5–822)
Positive predictive value
 Total 96.3 (96.2–96.4) 99.4 (99.3–99.5) 93.4 (93.3–93.5)
 High quality 96.0 (95.9–96.1) 99.3 (99.2–99.4) 91.4 (91.3–91.5)
 Average quality 97.3 (97.0–97.6) 99.6 (99.5–99.8) 97.5 (97.4–97.6)
Negative predictive value
 Total 55.9 (55.8–56.0) 52.0 (51.9–52.1) 75.4 (75.3–75.5)
 High quality 57.9 (57.8–57.9) 58.9 (58.8–59.0) 75.0 (74.9–75.1)
 Average quality 42.5 (42.1–42.9) 35.7 (35.6–35.8) 76.8 (76.5–77.0)
Youden index (J)
 Total 0.57 0.56 0.73
 High quality 0.56 0.60 0.69
 Average quality 0.59 0.48 0.84
Efficiency
 Total 72.8 (72.7–72.9) 70.3 (70.2–70.4) 85.75 (85.7–85.8)
 High quality 73.0 (72.9–73.1) 74.55 (74.5–74.6) 83.7 (83.6–83.8)
 Average quality 71.9 (71.7–72.1) 60.0 (59.9–60.1) 91.3 (91.2–91.4)
Prevalence% (95% CI)
 Total 66.0 (65.9–66.1) 67.8 (67.7–67.9) 64.2 (64.2–64.3)
 High quality 63.5 (63.4–63.6) 63.6 (63.5–63.7) 60.2 (60.1–60.3)
 Average quality 78.8 (78.7–79.0) 77.7 (77.6–77.8) 75.2 (75.1–75.3)