The influence of referral patterns on the characteristics of diagnostic tests.
The influence of referral patterns on the characteristics of diagnostic tests.
复制标题
转诊模式对诊断测试特征的影响。
DOI：
10.1016/0895-4356(92)90155-g
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发表时间：
1992
影响因子：
7.2
通讯作者：
Pieer Leffers
中科院分区：
文献类型：
--
作者：
J. AndréKnorrnerus;Pieer Leffers
诊断测试的歧视，其特征在于灵敏度，特异性，似然比和ROC曲线，可能会受到全科医生的转诊模式。特别是症状和测试结果。将影响转诊的概率，而病理过程的发展程度直接影响阳性检测结果的概率。通过数值例子，我们分析和讨论了几种具体情况：（1）转诊仅取决于症状;（2）转诊既取决于症状又取决于检查结果;（3）转诊仅取决于检查结果，在第一种情况下，检查特征和预测值在诊断学的层次上是不变的，而在第三种情况下，预测值是不变的。如果阳性检测结果与转诊概率呈正相关，则总体灵敏度将增加，而特异度和似然比将降低，并给出了似然比随转诊概率变化方向的一般表示。受试者工作特性曲线的形状对偏倚不太敏感，但在特定截止点的水平上可能会发生相当大的变化。
The discrimination of a diagnostic test—characterized by sensitivity, specificity, likelihood ratio and ROC curve—may be influenced by referral patterns of general practitioners. Symptoms and test results in particular. will affect the probability of referral, while the degree of development of the pathological process directly influences the probability of positive test results. Using numerical examples, we analyse and discuss a few specific situations: (1) referral depends only on symptoms; (2) referral depends both on symptoms and on test results; (3) referral depends only on test results.In the first situation, test characteristics and predictive values are invariant over the strata of symptomatology, while in the third situation the predictive values are unchanged. If there is a positive relationship between positive test results and referral probability, overall sensitivity will increase while specificity and likelihood ratio will decrease.A general representation is given for the evaluation of the direction of change of the likelihood ratio as a function of referral probabilities. The shape of receiver-operating characteristic curves is less sensitive to bias, but at the level of specific cut-off points considerable changes may occur.
冠状动脉疾病诊断和预后临床测试的比较准确性。
DOI：
10.1016/0002-9149(88)90889-2
发表时间：
1988
期刊：
The American journal of cardiology
影响因子：
--
作者：
Bobbio,M;Pollock,BH;Cohen,I;Diamond,GA
通讯作者：
Diamond,GA