Imprecision of Laboratory Determinations and Diagnostic Accuracy: Theoretical Considerations

Abstract

Recent studies suggest the determinations of clinical laboratories must be made more precise than at present. This paper presents a means of examining benefits of improvement in precision. To do this we use a mathematical model of the effect upon the diagnostic process of imprecision in measurements and the influence upon these two of Importance of Diagnosis and Prevalence of Disease. The interaction of these effects is grossly non-linear. There is therefore no proper intuitive answer to questions involving these matters. The effects can always, however, be calculated.Including a great many assumptions the modeling suggests that improvements in precision of any determination ought probably to be made in hospital rather than screening laboratories, unless Importance of Diagnosis is extremely high.