Assessment Tools and Diagnostic Tests in Adults and Children
In nursing practice, diagnostic testing is a frequently regulated activity performed by midwives and nurse practitioners. Patient assessment and screening for further testing require special skills that are crucial in nursing practice. Over the years, several studies have evaluated the effectiveness of assessment and diagnostic tools in the management of medical conditions in both children and adults (Kiiskinen et al., 2020). However, the methodological quality of most of these researches has been poor. As a result, nurses are required to utilize credible and reliable sources to promote the use of the highest quality assessment and diagnostic tools based on available evidence. This discussion illustrates the use and effectiveness of the monospot test for adults based on available evidence from literature sources.
Mononucleosis (Mono) Spot Test
A monospot test is a form of Heterophile antibody blood test used in the assessment and diagnosis of infectious mononucleosis (IM) by determining whether the patient has contracted Epstein-Barr virus (EBV (Stuempfig & Seroy, 2020)). The test is mainly looking for two heterophile antibodies in the patient’s blood, which normally appear during the process of infection or after an infection with EBV causing mononucleosis. The disease is common among late teens and young adults in their 20s (Cai et al., 2021). The test is usually requested for patients with symptoms of mononucleosis such as sore throat, fever, enlarged spleen, fatigue, and tender lymph nodes around the back of the neck. Just like any other blood test, during the monospot test, a sample of blood is collected from the patient and taken to the lab, and placed on a microscopic slide where it is mixed with other substances and observed for clumping (Wang et al., 2021). If the blood clumps, the test is considered positive, confirming the diagnosis of mononucleosis. Negative results would however mean that there are no heterophile antibodies in the patient’s blood, which is common within the first 1 to 2 weeks of infection. the highest number of heterophile antibodies are normally present after 2 to 5 weeks of infection with EBV.
Validity and Reliability of Monospot Test
Previous evidence report optimum sensitivity and specificity displayed by the monospot test supporting its high validity and reliability for use among the adult population. A study conducted by Kiiskinen et al. (2020) revealed that the monospot test is very specific with a sensitivity falling between the range of 70% and 90% in the diagnosis of infectious mononucleosis. The test has only been reported to be weak among the pediatric population, but effective among the adult population. Cai et al. (2021) also found that the monospot test has similar validity to the Paul–Bunnell test, with a specificity of 100% and a sensitivity of 92.9%. The monospot test is thus considered reliable.
However, some cases of false positive results with the use of the monospot test have been reported from other disease processes like herpes simplex virus, rubella, lymphoma, lupus, human immunodeficiency virus, and Cytomegalovirus (Stuempfig & Seroy, 2020). High rates of false negative results have also been reported among patients within the first or second week of infection. The sensitivity rates have been reported to peak at about 6 weeks of presentation of symptoms. In addition to the varying rates of sensitivity, the monospot test has also been reported to be unable to identify cases of heterophile negative infectious mononucleosis (Wang et al., 2021). Despite 90% of cases of infectious mononucleosis being caused by EBV, the remaining cases of heterophile negative infectious mononucleosis will display negative results with the monospot test even though the patient continues to present with symptoms. Serum testing is usually recommended at this point.
Just like any other diagnostic test, clinicians must understand the above limitations associated with the use of the monospot test and appreciate the population in which the test works best. Even though it is an inexpensive and rapid test, significant limitations and concerns especially with its sensitivity must be taken into account. As such, it should only be utilized among adults and children above the age of 4 years (Kiiskinen et al., 2020). The clinician must also ensure that the patient has presented with the symptoms of infectious mononucleosis for not less than 2 weeks. The EBV-specific antibody testing should however be considered for actual confirmation of infectious mononucleosis caused by EBV. Serum testing is recommended for specific causative agents for patients with symptoms of IM but negative for spot tests.
Conclusion
In the assessment and diagnosis of patients, the selection of which screening tool to utilize is crucial. Clinicians are thus encouraged to utilize literature sources for evidence-based diagnostic tools, to promote accurate diagnosis of the patient. As discussed above, the monospot test is recommended for the diagnosis of infectious mononucleosis caused by EBV preferable among adults. The test is however weak among the pediatric population but can be used among children above the age of 4 years. Despite the high validity and reliability of the diagnostic tool, EBV-specific antibody testing is recommended to confirm the diagnosis of infectious mononucleosis caused by EBV.
References
Cai, X., Ebell, M. H., & Haines, L. (2021). Accuracy of Signs, Symptoms, and Hematologic Parameters for the Diagnosis of Infectious Mononucleosis: A Systematic Review and Meta-Analysis. The Journal of the American Board of Family Medicine, 34(6), 1141–1156. https://doi.org/10.3122/jabfm.2021.06.210217
Kiiskinen, S. J., Luomala, O., Häkkinen, T., Lukinmaa-Åberg, S., & Siitonen, A. (2020). Evaluation of the Serological Point-of-Care Testing of Infectious Mononucleosis by Data of External Quality Control Samples. Microbiology Insights, 13. https://doi.org/10.1177/1178636120977481
Stuempfig, N. D., & Seroy, J. (2020). Monospot Test. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539739/
Wang, E. X., Kussman, A., & Hwang, C. E. (2021). Use of Monospot Testing in the Diagnosis of Infectious Mononucleosis in the Collegiate Student-Athlete Population. Clinical Journal of Sports Medicine, Publish Ahead of Print. https://doi.org/10.1097/jsm.0000000000000996
