Diagnostic test accuracy may vary with prevalence: implications for evidence-based diagnosis

Leeflang, Mariska; Bossuyt, Patrick M.; Irwig, Les

doi:10.1016/j.jclinepi.2008.04.007

Cited by 376 publications

(290 citation statements)

References 39 publications

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“…The dominating principle of this study was to incorporate a wide range of common pain disorders as seen in everyday clinical practice (13,14). Subjects were recruited from the practices of 5 rheumatologists, 2 pain specialists, and 1 psychologist, with locations including Cooper Medical School in Camden, New Jersey; Rheumatology Associates of Long Island in Stonybrook, New York; Oregon Health & Science University in Portland, Oregon; Providence Medical Center in Portland, Oregon; University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania; and a private psychology practice in Portland, Oregon.…”

Section: Methodsmentioning

confidence: 99%

Criteria for the Diagnosis of Fibromyalgia: Validation of the Modified 2010 Preliminary American College of Rheumatology Criteria and the Development of Alternative Criteria

Bennett

Friend

Marcus³

et al. 2014

Arthritis Care & Research

108

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Objective. To validate the 2011 modification of the 2010 American College of Rheumatology (ACR) preliminary criteria for the diagnosis of fibromyalgia (2011ModCr) and develop alternative criteria in a sample of patients with diverse pain disorders that are commonly seen in everyday practice by pain specialists, rheumatologists, and psychologists. Methods. Eight clinicians from geographically varied locations in the US evaluated patients with chronic pain and psychiatric disorders using a standard set of questions that included the 2011ModCr questions, the Symptom Impact Questionnaire (SIQR), a 28-area pain location inventory (PLI), and the Short Form 36. Alternative diagnostic criteria were developed from the same data set using logistic regression and receiver operating curve analysis. Results. Complete data on 321 patients were evaluated; there were 135 patients with fibromyalgia (according to the 1990 ACR criteria) and 186 patients with 16 other common chronic pain problems. Comparing the 2011ModCr with the 1990 ACR criteria provided a sensitivity of 83%, a specificity of 67%, and a correct classification of 74%. Alternative criteria were derived from the 10-item symptom score from the SIQR symptoms and the 28-area PLI. Maximal diagnostic accuracy was obtained with >17 pain sites (range 0 -28) and an SIQR symptom score of >21 (range 0 -50). These alternative criteria had a diagnostic sensitivity of 81%, a specificity of 80%, and a correct classification of 80%. Conclusion. The 2011ModCr had robust operating characteristics. Alternative criteria based on symptom items from the SIQR and pain locations from the PLI had comparable operating characteristics, with somewhat better specificity and ease of use.

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Section: Methodsmentioning

confidence: 99%

Criteria for the Diagnosis of Fibromyalgia: Validation of the Modified 2010 Preliminary American College of Rheumatology Criteria and the Development of Alternative Criteria

Bennett

Friend

Marcus³

et al. 2014

Arthritis Care & Research

108

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“…19 New transient elastography probes (XL probe), as well as new sonoelastography methods, might overcome this limitation of transient elastography, 34 with the added advantage of improving the applicability of measurement of spleen stiffness, which is emerging as a novel noninvasive parameter closely correlating with HVPG and presence of EVs. 35,36 Second, the prevalence of EVs in our population of compensated patients was relatively low, which might represent a bias for the generalizability of our results 37 ; however, the prevalence of varices in the validation cohort was exactly as anticipated. It should also be noted that patients included in the training set and in the validation set differed in a number of characteristics; however, the similar results obtained by applying our models in the validation set further confirms the robustness of our findings.…”

Section: Clinical Livermentioning

confidence: 75%

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

et al. 2013

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BACKGROUND & AIMS:Noninvasive methods are needed to identify clinically significant portal hypertension (CSPH) and esophageal varices (EVs) in patients with compensated cirrhosis. We looked for markers of the presence of CSPH and EVs in patients with cirrhosis. METHODS: We performed a cross-sectional study that included a training set of 117 patients with compensated cirrhosis, confirmed by histology, from a tertiary referral center. Spleen diameter was measured by ultrasound and liver stiffness (LS) was measured by transient elastography; endoscopy was used as the standard for detection of EVs and measurements of hepatic venous pressure gradient were used as the standard for identifying CSPH. We assessed the ability of platelet count, spleen diameter, LS, and combinations of these factors (ie, ratio of platelet count to spleen size, and LS ϫ spleen size/platelet count [LSPS]) to identify patients with CSPH and EV. The analysis included 2 new statistical models: the PH risk score and the varices risk score. Results were validated using an independent series of 56 patients with compensated patients from another center. RESULTS: LS was the best single noninvasive variable for identifying patients with CSPH (area under the receiver operating characteristic, 0.883; 95% confidence interval [CI], 0.824 -0.943; P Ͻ .0001). The area under the receiver operating characteristic value increased when LS was combined with platelet count and spleen size, either as LSPS (0.918; 95% CI, 0.872Ϫ0.965; P Ͻ .0001) or PH risk score (0.935; 95% CI, 0.893-0.977; P Ͻ .0001). More than 80% of patients were accurately classified using LSPS and PH risk score. Analyses of the varices risk score and LSPS were superior to all other noninvasive tests for identifying patients with EVs (area under the receiver operating characteristic, 0.909; 95% CI, 0.841Ϫ0.954 and 0.882; 95% CI, 0.810 -0.935, respectively); they correctly classified 85% of patients in the training set and 75% in the validation set. CONCLUSIONS: Combined data on LS, spleen diameter, and platelet count can be used to identify patients with compensated cirrhosis most likely to have CSPH and EV.

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“…For example, a patient population with a higher disease prevalence may include more severely diseased patients; therefore, the test would perform better in this population. 39 It is also important to emphasize that an ideal diagnostic test in a general population should have a relatively high specificity to minimize false positives, nevertheless, it should have sufficient sensitivity. Conversely, an ideal diagnostic test in a population with a high pre-test probability of disease should have higher sensitivity while maintaining high specificity.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of screening questionnaires for obstructive sleep apnea

Abrishami

Khajehdehi

Chung

2010

Can J Anesth/J Can Anesth

483

341

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Purpose Obstructive sleep apnea (OSA) may lead to lifethreatening problems if it is left undiagnosed. Polysomnography is the ''gold standard'' for OSA diagnosis; however, it is expensive and not widely available. The objective of this systematic review is to identify and evaluate the available questionnaires for screening OSA. Source We carried out a literature search through MEDLINE, EMBASE, and CINAHL to identify eligible studies. The methodological validity of each study was assessed using the Cochrane Methods Group's guideline. Principal findings Ten studies (n = 1,484 patients) met the inclusion criteria. The Berlin questionnaire was the most common questionnaire (four studies) followed by the Wisconsin sleep questionnaire (two studies). Four studies were conducted exclusively on ''sleep-disorder patients'', and six studies were conducted on ''patients without history of sleep disorders''. For the first group, pooled sensitivity was 72.0% (95% confidence interval [CI]: 66.0-78.0%; I 2 = 23.0%) and pooled specificity was 61.0% (95% CI: 55.0-67.0%; I 2 = 43.8%). For the second group, pooled sensitivity was 77.0% (95% CI: 73.0-80.0%; I 2 = 78.1%) and pooled specificity was 53.0% (95% CI: 50-57%; I 2 = 88.8%). The risk of verification bias could not be eliminated in eight studies due to insufficient reporting. Studies on snoring, tiredness, observed apnea, and high blood pressure (STOP) and STOP including body mass index, age, neck circumference, gender (Bang) questionnaires had the highest methodological quality. ConclusionThe existing evidence regarding the accuracy of OSA questionnaires is associated with promising but inconsistent results. This inconsistency could be due to studies with heterogeneous design (population, questionnaire type, validity). STOP and STOP-Bang questionnaires for screening of OSA in the surgical population are suggested due to their higher methodological quality and easyto-use features. RésuméObjectif L'apne´e obstructive du sommeil (AOS) peut provoquer des proble`mes de sante´fatals si elle n'est pas diagnostique´e. La polysomnographie est «l'e´talon or» du diagnostic de l'AOS; cependant, cette me´thode est one´reuse et n'est pas disponible partout. L

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Diagnostic test accuracy may vary with prevalence: implications for evidence-based diagnosis

Cited by 376 publications

References 39 publications

Criteria for the Diagnosis of Fibromyalgia: Validation of the Modified 2010 Preliminary American College of Rheumatology Criteria and the Development of Alternative Criteria

Criteria for the Diagnosis of Fibromyalgia: Validation of the Modified 2010 Preliminary American College of Rheumatology Criteria and the Development of Alternative Criteria

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

A systematic review of screening questionnaires for obstructive sleep apnea

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