What White Blood Cell Count Should Prompt Antibiotic Treatment in a Febrile Child? Tutorial on the Importance of Disease Likelihood to the Interpretation of Diagnostic Tests

Author:

Kohn Michael A.1,Newman Thomas B.1

Affiliation:

1. Department of Epidemiology and Biostatistics, University of California, San Francisco

Abstract

Most diagnostic tests are not dichotomous (negative or positive) but, rather, have a range of possible results (very negative to very positive). If the pretest probability of disease is high, the test result that prompts treatment should be any value that is even mildly positive. If the pretest probability of disease is low, the test result needed to justify treatment should be very positive. Simple decision rules that fix the cutpoint separating positive from negative test results do not take into account the individual patient’s pretest probability of disease. Allowing the cutpoint to change with the pretest probability of disease increases the value of the test. This is primarily an issue when the pretest probability of disease varies widely between patients and depends on characteristics that are not measured by the test. It remains an issue for decision rules based on multiple test results if these rules fail to account for important determinants of patient-specific risk. This tutorial demonstrates how the value of a diagnostic test depends on the ability to vary the cutpoint, using as an example the white blood cell count in febrile children at risk for bacteremia.

Publisher

SAGE Publications

Subject

Health Policy

Cited by 6 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Multilevel and Continuous Tests;Evidence-Based Diagnosis;2020-06-25

2. Integration of Meta-analysis and Economic Decision Modeling for Evaluating Diagnostic Tests;Medical Decision Making;2008-06-30

3. Marqueurs biologiques de l'inflammation dans les centres d'urgences pédiatriques;Archives de Pédiatrie;2005-06

4. Likelihood Ratio Reporting: In Response;Mayo Clinic Proceedings;2005-04

5. Likelihood Ratio Reporting;Mayo Clinic Proceedings;2005-04

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3