The indication area of a diagnostic test. Part I--discounting gain and loss in diagnostic certainty
Published by Elsevier Inc..
OBJECTIVES: Test performance is conventionally expressed by gain in diagnostic certainty. We propose net diagnostic gain and indication area as more appropriate measures of test performance; then, the loss in certainty due to misclassification and the information of "no test" would be performed are taken into account.
STUDY DESIGN AND SETTING: A decision analytical model was developed in which two alternative strategies were compared: testing and no testing. Correct diagnostic test results received a positive value; undesired test results received a negative value. Within the "no test" scenario, it was assumed that physicians are more prone to treat as the probability of disease is higher.
RESULTS: Discounting gain and loss in diagnostic certainty results in a concave function of the prior. The indication area is the range of priors with a net diagnostic gain; testing is deleterious beyond this range. The net diagnostic gain reaches a maximum at a specific prior. A freely available Web site-based calculator was developed for easy calculation of the indication area and the maximum diagnostic gain for each combination of sensitivity and specificity.
CONCLUSION: Medical testing is not indicated when the prior disease probabilities are low (as to screening for a condition) or high (for diagnostic confirmation).
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2015 |
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| Erschienen: |
2015 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:68 |
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| Enthalten in: |
Journal of clinical epidemiology - 68(2015), 10 vom: 03. Okt., Seite 1120-8 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Stalpers, Lukas J A [VerfasserIn] |
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| Links: |
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| Themen: |
Diagnostic test |
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| Anmerkungen: |
Date Completed 29.04.2016 Date Revised 08.04.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jclinepi.2015.05.016 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM250556499 |
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| 100 | 1 | |a Stalpers, Lukas J A |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The indication area of a diagnostic test. Part I--discounting gain and loss in diagnostic certainty |
| 264 | 1 | |c 2015 | |
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| 500 | |a Date Completed 29.04.2016 | ||
| 500 | |a Date Revised 08.04.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Published by Elsevier Inc. | ||
| 520 | |a OBJECTIVES: Test performance is conventionally expressed by gain in diagnostic certainty. We propose net diagnostic gain and indication area as more appropriate measures of test performance; then, the loss in certainty due to misclassification and the information of "no test" would be performed are taken into account | ||
| 520 | |a STUDY DESIGN AND SETTING: A decision analytical model was developed in which two alternative strategies were compared: testing and no testing. Correct diagnostic test results received a positive value; undesired test results received a negative value. Within the "no test" scenario, it was assumed that physicians are more prone to treat as the probability of disease is higher | ||
| 520 | |a RESULTS: Discounting gain and loss in diagnostic certainty results in a concave function of the prior. The indication area is the range of priors with a net diagnostic gain; testing is deleterious beyond this range. The net diagnostic gain reaches a maximum at a specific prior. A freely available Web site-based calculator was developed for easy calculation of the indication area and the maximum diagnostic gain for each combination of sensitivity and specificity | ||
| 520 | |a CONCLUSION: Medical testing is not indicated when the prior disease probabilities are low (as to screening for a condition) or high (for diagnostic confirmation) | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Diagnostic test | |
| 650 | 4 | |a Indication area | |
| 650 | 4 | |a Maximum diagnostic gain | |
| 650 | 4 | |a Prevalence | |
| 650 | 4 | |a Sensitivity | |
| 650 | 4 | |a Specificity | |
| 700 | 1 | |a Nelemans, Patty J |e verfasserin |4 aut | |
| 700 | 1 | |a Geurts, Sandra M E |e verfasserin |4 aut | |
| 700 | 1 | |a Jansen, Erik |e verfasserin |4 aut | |
| 700 | 1 | |a de Boer, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Verbeek, André L M |e verfasserin |4 aut | |
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| 773 | 1 | 8 | |g volume:68 |g year:2015 |g number:10 |g day:03 |g month:10 |g pages:1120-8 |
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