Assessing Diagnostic Tool

Dwi Agustian
20/10/2015

Main Question
Do we have good enough diagnostic
tool?
What is normal? Abnormal?
What is the diagnosis criteria?
What is the quality measures of good
diagnostic tool?

Example of Biological
Variation

Validity
The validity of a test is defined as its
ability to distinguish between who
has a disease and who does not:
sensitivity and specificity.
The sensitivity of the test is defined as
the ability of the test to identify correctly
those who have the disease.
The specificity of the test is defined as
the ability of the test to identify correctly
those who do not have the disease.

Example

Concept

Reality [in medical practice]

Multiple Test
Sequential

Net Sensitivity and Net

Specificity
315 people of the total 500 people with
diabetes in this population of 10,000
will have been correctly called positive:
315/500 = 63% net sensitivity
-> a loss in net sensitivity
7,600 + 1,710 of the 9,500 nondiabetics
were correctly called negative:
9,310/9,500 = 98% net specificity
-> a gain in net specificity

 Simultaneous Test
the net
sensitivity
using tests A
and B
simultaneousl
y:

-> a gain in net

sensitivity

 the net
specificity
= 432/800
=
54% net
specificity
-> a loss in
net
specificity

Summary
When two sequential tests are used
and those who test positive by the
first test are brought in for the second
test, there is a net loss in sensitivity,
but a net gain in specificity, compared
with either test alone.
When two simultaneous tests are
used, there is a net gain in sensitivity
and a net loss in specificity, compared
with either test alone.

When multiple testing?

Diagnostic vs Screening
Cost - Insurance
Length of Stay
Degree of invasiveness

Predictive Value
If the test results are
positive/negative in this patient,
what is the probability that this
patient has/has not the disease?

Example

The predictive value is affected by

two factors:
the prevalence of the disease in
the population tested and,
when the disease is infrequent,
the specificity of the test being
used

Example

Relationship of Predictive Value and

Prevalence

Relationship between Positive

Predictive Value and Specificity of
the Test

RELIABILITY (REPEATABILITY) OF
TESTS
The factors that contribute to
the variation between test
results are:
intrasubject variation (variation
within individual subjects),
intraobserver variation (variation in
the reading of test results by the
same reader), and
interobserver variation (variation
between those reading the test
results).

Test is not valid

Referensi
Webb, Chapter 14
Gordis, Chapter 5