Pocket Guide to Diagnostic Tests-0838581358.pdf

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14 Pocket Guide to Diagnostic Tests .1 99 .2 .5 95 1 1000 500 90 2 5 10 200 100 50 20 10 5 80 70 60 50 40 % 20 30 40 50 60 70 80 2 1 .5 .2 .1 .05 .02 .01 .005 30 20 10 5 2 % 90 .002 .001 1 95 .5 .2 99 Pretest probability Likelihood ratio .1 Posttest probability Figure 1–7. Nomogram for determining posttest probability from pretest probability and likelihood ratios. To figure the posttest probability, place a straightedge between the pretest probability and the likelihood ratio for the particular test. The posttest probability will be where the straightedge crosses the posttest probability line. (Adapted and reproduced, with permission, from Fagan TJ: Nomogram for Bayes’s theorem. N Engl J Med 1975;293:257.)
Basic Principles of Diagnostic Test Use and Interpretation 15 A more formal way of calculating posttest probabilities uses the likelihood ratio as follows: Pretest odds × Likelihood ratio = Posttest odds To use this formulation, probabilities must be converted to odds, where the odds of having a disease are expressed as the chance of having the disease divided by the chance of not having the disease. For instance, a probability of 0.75 is the same as 31 odds (Figure 1–8). To estimate the potential benefit of a diagnostic test, the clinician first estimates the pretest odds of disease given all available clinical information and then multiplies the pretest odds by the positive and negative likelihood ratios. The results are the posttest odds, or the odds that the patient has the disease if the test is positive or negative. To obtain the posttest probability, the odds are converted to a probability (Figure 1–8). For example, if the clinician believes that the patient has a 60% chance of having a myocardial infarction (pretest odds of 32) and the creatine kinase MB test is positive (LR + = 32), then the posttest odds of having a myocardial infarction are Odds = Probability 1 – Probability Example: If probability = 0.75, then Odds = Probability = 0.75 1 – 0.75 Odds Odds + 1 0.75 3 = = = 3:1 0.25 1 Example: If odds = 3:1, then Probability = 3/1 3/1 + 1 = 3 3 + 1 = 0.75 Figure 1–8. Formulas for converting between probability and odds.
Page 2 and 3: ABBREVIATIONS AND ACRONYMS Ab Antib
Page 4 and 5: McGraw-Hill abc Copyright © 2001 b
Page 6 and 7: Associate Authors G. Thomas Evans,
Page 8 and 9: In this environment, students, hous
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Test /Range/Collection Physiologic
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188 Pocket Guide to Diagnostic Test
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TABLE 4-1 (CONTINUED). Drug Effecti
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TABLE 4-1 (CONTINUED). Quinidine Sa
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Organism Specimen /Diagnostic Tests
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Sinusitis Organism Specimen /Diagno
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Cellulitis Organism Specimen /Diagn
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Test Indications Advantages BRAIN E
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Test Indications Advantages NECK Ev
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Test Indications Advantages THYROID
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Test Indications Advantages CHEST E
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Test Indications Advantages LUNG Ev
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Test Indications Advantages BREAST
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Test Indications Advantages ABDOMEN
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Test Indications Advantages ABDOMEN
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GI Upper GI study (UGI) $$ GI Enter
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GI Hypaque enema $$ GI Esophageal r
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GALL- BLADDER Ultrasound (US) $ GAL
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Test Indications Advantages LIVER S
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LIVER/ BILIARY TREE Percutaneous tr
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Test Indications Advantages PANCREA
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GENITO- URINARY Renal scan (radionu
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Test Indications Advantages BONE Bo
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MUSCULO- SKELETAL SYSTEM Magnetic r
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AORTA AND ITS BRANCHES Magnetic res
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Normal Isotonic hyponatremia Serum
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Signs and symptoms Typical for PE A
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TABLE 8-1. ACID-BASE DISTURBANCES:
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TABLE 8-3. ANEMIA, MICROCYTIC: LABO
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TABLE 8-4 (CONTINUED). Serum- Ascit
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TABLE 8-5 (CONTINUED). Suspected Pr
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TABLE 8-6 (CONTINUED). Opening CSF
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TABLE 8-8 (CONTINUED). Test/Range/C
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TABLE 8-8 (CONTINUED). Test/Range/C
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TABLE 8-10. HEPATIC FUNCTION TESTS.
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TABLE 8-11 (CONTINUED). Lipoprotein
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TABLE 8-13. PLEURAL FLUID: PLEURAL
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TABLE 8-14. PRENATAL DIAGNOSTIC MET
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TABLE 8-18. RENAL TUBULAR ACIDOSIS
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TABLE 8-19 (CONTINUED). Gram Type o
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TABLE 8-23 (CONTINUED). PREGNANCY H
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TABLE 8-24 (CONTINUED). Daily Speci
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TABLE 8-26. VALVULAR HEART DISEASE:
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TABLE 8-27. WHITE BLOOD CELLS: WHIT
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TABLE 8-28 (CONTINUED). Not Indicat
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404 Index Acetaminophen (cont.) tox
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406 Index Agammaglobulinemia, prote
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408 Index Amitriptyline therapeutic
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410 Index Anti-insulin antibodies,
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412 Index Arthropathy, neuropathic,
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414 Index Bacteremia (cont.) perine
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416 Index Biliary tract (cont.) obs
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418 Index Brain abscess neighborhoo
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420 Index Candida (cont.) test sele
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422 Index Cervical cancer -fetoprot
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424 Index Chronic obstructive airwa
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426 Index Colitis (cont.) ulcerativ
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428 Index Corynebacterium jeikeium,
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430 Index D D antigen, Rh, testing
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432 Index Digibind, digoxin monitor
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434 Index Echinococcus multilocular
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436 Index Enterobacteriaceae, test
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438 Index Esophageal reflux study,
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440 Index Fecal contamination, urin
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442 Index Furosemide carbon dioxide
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444 Index Glomerulonephritis (cont.
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446 Index Haemophilus influenzae, t
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448 Index Hemolytic anemia cold agg
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450 Index Hepatotoxic drugs (cont.)
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452 Index Hypercoagulability. See a
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454 Index Hyponatremia (cont.) hype
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456 Index Immunodiffusion in fungal
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458 Index Intravascular hemolysis h
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460 Index Kidney disease (cont.) 1
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462 Index Left ventricular hypertro
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464 Index Liver (cont.) cancer of (
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466 Index Lymphadenopathy (cont.) m
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468 Index Medial cutaneous nerve of
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470 Index Mixed connective tissue d
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472 Index Myeloma (cont.) IgG level
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474 Index Neisseria meningitidis, t
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476 Index Nucleic acid assay in muc
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478 Index Paget’s disease (cont.)
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480 Index Pericholecystic fluid, ul
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482 Index Pneumonectomy, evaluation
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484 Index Precordial leads, ECG, lo
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486 Index Protoporphyria, free eryt
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488 Index QRS complex (cont.) in in
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490 Index Renal failure (cont.) cal
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492 Index Rickets 1,25(OH) 2 -resis
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494 Index Seafood, raw, cellulitis
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496 Index Specimen identification,
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498 Index Steroids (cont.) phosphor
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500 Index Synovial fluid sampling i
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502 Index Therapeutic drug monitori
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504 Index Tourniquet, prolonged use
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506 Index Tube feedings, serum osmo
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508 Index Uterus (cont.) enlarged,
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510 Index Vitamin B 6 deficiency (p
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NOTES Copyright 2001 The McGraw-Hil
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