title: Visual inspection versus spectrophotometry in detecting bilirubin in cerebrospinal fluid.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of visual inspection and spectrophotometry for identifying the presence of bilirubin in the cerebrospinal fluid (CSF).
  
  
  METHODS
  Clinicians and students assessed CSF specimens with seven degrees of extinction between 0.00 and 0.09 at 450-460 nm as "yellow," "doubtful," or "colourless" after random presentation under standard conditions. The assessments were compared with spectrophotometry, with 0.05 being taken as the cut off level for the presence of bilirubin. Results were compared between the two groups and explored by means of receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  All 51 clinicians and 50 of 51 students scored the tubes with extinction of 0.06 or higher as "yellow" or "doubtful." Tubes without any bilirubin were scored as "yellow" by three of the students only. The ROC curves confirmed that the diagnostic properties of the visual inspection versus spectrophotometry were slightly better for the clinicians than for the students.
  
  
  CONCLUSIONS
  If CSF is considered colourless, the extinction of bilirubin is too low to be compatible with a diagnosis of recent subarachnoid haemorrhage. If CSF is not considered colourless, spectrophotometry should be carried out to determine the level of extinction of bilirubin.
authors.affiliation: Department of Neurology, University Medical Centre/Central Military Hospital, Heidelberglaan 100, 3584 CX Utrecht, Netherlands. f.h.h.linn@neuro.azu.nl
authors.forename: F H H
authors.initials: FH
authors.lastname: Linn
authors.forename: H A M
authors.initials: HA
authors.lastname: Voorbij
authors.forename: G J E
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: A
authors.initials: A
authors.lastname: Algra
authors.forename: J
authors.initials: J
authors.lastname: van Gijn
mesh_terms: D001663:Bilirubin / Q000134:cerebrospinal fluid*; D006801:Humans; D011361:Professional Competence; D013053:Spectrophotometry / Q000295:instrumentation*; D013334:Students; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid*; D014796:Visual Perception / Q000502:physiology*
chemical_list: D001663:Bilirubin