Decisions of when to order and how to interpret diagnostic tests form the cornerstone of medical care. However, interpreting a patients test results in the context of their clinical presentation is not always straightforward. The objective rigor of diagnostic tests may be perceived as providing superior information, compared to the clinical evaluation. Prior studies demonstrate that clinicians at all levels of experience and fields of expertise may not consistently incorporate two critical points of uncertainty in diagnostic decision making:: imperfect test accuracy and the pre-test probability of the disease being investigated. This book highlights some pitfalls in diagnostic reasoning in this regard, and emphasizes strategies to incorporate clinical and diagnostic information, including uncertainty therein, to optimize diagnostic reasoning.
Introduction; The Basic 2x2 Dichotomized System of Diagnostic Test Properties; Sensitivity & Specificity:: From Population to Individual; Different Contributions of Sensitivity & Specificity to Predictive Value, & The Spin / Snout Shortcut; Optimizing Test Strategies Depends on Where You Are, & Where You Want to Go; Choosing Among Diagnostic Tests:: Revisiting Spin / Snout; Clinical Examples Using the Likelihood Ratio & Bayes Theorem; Do All Unexpected Results Increase Uncertainty?; When Should an Unexpected Result Compel You to Switch Diagnostic Sides?; Discussion; Index.
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