Stats #74: Use of diagnostic tests for making clinical decisions

Content: This training class will discuss the evaluation of diagnostic tests.

Teaching strategies: Didactic lectures and small group exercises.

Abstract: Not all diagnostic tests are created equal. Some are so bad that they cause more harm than good. After reviewing the general formulas for sensitivity and specificity, I will outline the five phases of research for development of a diagnostic test proposed by Margaret Pepe. I will then explain why research in the early phases provides an insufficient evidence base for making clinical decisions about the utility of a diagnostic test. Finally, I will illustrate how to apply a diagnostic test in a practical setting that incorporate clinical judgment and accounts for individual patient variation. In this talk, you will learn how to: describe the limitations of diagnostic tests, summarize the five phase of diagnostic test development, and apply diagnostic tests in a practical setting.

Objectives: In this seminar, you will learn how to:

• compute classic measures of diagnostic test performance,
• appraise the quality of research on a diagnostic test, and
• apply diagnostic test results to an individual patient.

Notes: There are no pre-requisites for this seminar. This class does not qualify for IRB Education Credits (IRBECs).

I've been asked to remove any personal details from this web site. That included this page. Sorry!

Information about my book, Statistical Evidence in Medical Trials

I recently published a book, Statistical Evidence in Medical Trials, What do the Data Really Tell Us? through Oxford University Press. A good summary of what this book is about appears on the back cover: "Statistical Evidence in Medical Trials is a lucid, well-written and entertaining text that addresses common pitfalls in evaluating medical research. Including extensive use of publications from the medical literature and a non-technical account of how to appraise the quality of evidence presented in these publications, this book is ideal for health care professionals, students in medical or nursing schools, researchers and students in statistics, and anyone needing to assess the evidence published in medical journals." A review by Rebecca Rooney in the International Journal of Epidemiology states: "This book is a clear, concise, and interesting read and should prove to be a useful guide. The examples and case studies make it easy to understand difficult concepts and the jokes and stories make it fun. There are some salient points and hopefully the reader will be enthused about looking at the published research and be more confident about distinguishing between the good and the bad." More information about the book (supporting materials, answers to the exercises, and other updates) can be found on the web at http://www.childrensmercy.org/stats/evidence.asp.

Where can you find this handout?

This handout and the handouts that I use for all of my seminars and training classes are a compilation of individual web pages at www.childrensmercy.org/stats. I use the "Include Page" feature of Microsoft FrontPage to combine these into a single page. You can always find the most recent version of this compilation by going to the web address listed at the bottom of this page. Links for the handouts for other seminars and classes appear at www.childrensmercy.org/stats/training.asp.

Why don't I use PowerPoint?

I stopped using PowerPoint for my presentations in the mid 1990's. This was based on Edward Tufte's advice that presenting information in a paper handout is more effective than presenting the information on a projected screen. I found this to be excellent guidance. I enjoy talking when I don't have to wrestle with a laptop computer. I look at my audience more and interact with them better. I elaborate on this in greater detail at www.childrensmercy.org/stats/weblog2004/powerpoint.asp.