American Journal of Epidemiology Vol. 121, No. 5: 744-753
Copyright © 1985 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
MEASURES OF GAIN IN CERTAINTY FROM A DIAGNOSTIC TEST1
(Reprint requests to Dr. Fred A. Connell.)
Received for publication December 22, 1983. Revision received June 11, 1984. The authors propose several measures for quantifying the change in the clinical estimate of a patient's chances of having a disease that occurs as a result of diagnostic testing. Under most circumstances, the gain in clinical certainty from a positive test result is more affected by the specificity (T) of the test, while the gain from a negative test result is more affected by sensitivity (S). The prevalence of the disease in the tested population is also an Important determinant of the magnitude of gain in certainty. Measures of the expected gain in certainty can be calculated by weighting the gains from a positive or negative result by the likelihood of the respective test outcome. Indices of expected gain depend directly on the quantity S + T, implying that sensitivity and specificity have equal Importance in determining expected gain. When S + T = 1, the test provides no information; when S + T Is greatest, the expected gain is maximized. Expected gain is also related to the receiver operating characteristic curve for a diagnostic test the point on the receiver operating characteristic curve at which S + T is greatest corresponds to the point at which the distance from the major diagonal is greatest and at which the slope of the receiver operating characteristic curve equals 1.
decision making; diagnostic tests, routine; epidemiologic methods
1 School of Public Health and Community Medi. cine, University of Washington, SC-37, Seattle, WA 98195
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Uyttenboogaart, R. E. Stewart, P. C.A.J. Vroomen, J. De Keyser, and G.-J. Luijckx Optimizing Cutoff Scores for the Barthel Index and the Modified Rankin Scale for Defining Outcome in Acute Stroke Trials Stroke, September 1, 2005; 36(9): 1984 - 1987. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P C A J Vroomen, M C T F M de Krom, J T Wilmink, A D M Kester, and J A Knottnerus Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression J. Neurol. Neurosurg. Psychiatry, May 1, 2002; 72(5): 630 - 634. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Lanska, I. Zerr, and S. Poser Diagnosis of Creutzfeldt-Jakob disease: Effect of clinical criteria on incidence estimates Analysis of EEG and CSF 14-3-3 proteins as aids to the diagnosis of Creutzfeldt-Jakob disease Neurology, May 22, 2001; 56(10): 1422 - 1423. [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Zalenski, M. McCarren, R. Roberts, R. J. Rydman, B. Jovanovic, K. Das, J. Mendez, M. El-Khadra, L. Fraker, and M. McDermott An Evaluation of a Chest Pain Diagnostic Protocol to Exclude Acute Cardiac Ischemia in the Emergency Department Arch Intern Med, May 26, 1997; 157(10): 1085 - 1091. [Abstract] [PDF]
|
|
|
|
 |
|
 D. Lanska A Public/Private Partnership in the Quest for Quality: Development of Cerebrovascular Disease Practice Guidelines and Review Criteria American Journal of Medical Quality, June 1, 1995; 10(2): 100 - 106. [Abstract] [PDF]
|
|
|
|
 |
|
 J. A. Knottnerus Application of Logistic Regression to the Analysis of Diagnostic Data: Exact Modeling of a Probability Tree of Multiple Binary Variables Med Decis Making, June 1, 1992; 12(2): 93 - 108. [Abstract] [PDF]
|
|
|
|
|
|
D. A. Asch, J. P. Patton, and J. C. Hershey Knowing for the Sake of Knowing: The Value of Prognostic Information Med Decis Making, February 1, 1990; 10(1): 47 - 57. [Abstract] [PDF]
|
|
|
|
|
|
A. Hartz and R. Centor Measures of the Value of a Diagnostic Test Derived from Stochastic Thresholds Med Decis Making, August 1, 1986; 6(3): 149 - 153. [Abstract] [PDF]
|
|