診斷文獻的評讀.pptVIP

診斷文獻的評讀 李智雄 高雄醫學大學附設中和紀念醫院 實證醫學中心 Diagnosis 診斷 Diagnosis 診斷 Diagnosis 診斷 Positive Likelihood Ratio (陽性相似比) LR＋ True positive rate / False positive rate Sensitivity / ( 1－Specificity ) The amount by which the pretest probability is increased in patients with a positive test LR+ ≧4 valuable, LR+ ≧10 good Negative Likelihood Ratio (陰陽性相似比) LR－ False negative rate / True negative rate ( 1－Sensitivity) / Specificity The amount by which the pretest probability of disease is reduced in patients with a negative test LR- ≦0.6 useful, LR- ≦0.1 good Serum Ferritin and IDA Critical Appraisal of Diagnostic Accuracy Study“診斷工具”的評析 Are the results of the study valid (效度如何)？ Was the diagnostic test evaluated in a representative spectrum of patients (是否經過具有代表性的病人群測試過)？ Was the reference standard ascertained regardless of the index test result (標準診斷工具做確診時不知道指標診斷工具的結果)？ Was there an independent, blind comparison between the index test and an appropriate gold standard of diagnosis (標準診斷工具與指標診斷工具是在獨立且雙盲的情況下進行比較)？ What were the results (結果是甚麼)？ Are test characteristics presented (呈現指標診斷工具的特性)？ Can we apply to our patient (可以應用到我的病人嗎)？ Was the diagnostic test evaluated in a representative spectrum of patients 是否經過具有代表性的病人群測試過？ Was the reference standard ascertained regardless of the index test result 標準診斷工具做確診時不知道指標診斷工具的結果？ Was there an independent, blind comparison between the index test and an appropriate gold standard of diagnosis標準診斷工具與指標診斷工具是在獨立且雙盲的情況下進行比較？ Are test characteristics presented 呈現指標診斷工具的特性？ 診斷工具的研究，結果常以兩種方式呈現： 檢驗或檢查的準確度 Sensitivity (敏感度) Sn Specificity (特異度) Sp 檢驗或檢查在某一群體的預測值 Positive predictive value (陽性預測值 ) PPV Negative predictive value (陰性預測值 ) NPV Test Characteristics LR+ = Sensitivity / (1-specificity) 0.96 / (1 – 0.8) = 4.8 LR- = (1-sensitivity) / specificity (1 – 0.96) / 0.8 = 0.05 Pre-test odds = prevalence / (1 - prevalence) 0.25 / 0.75 = 0.3333 Post-test odds = pre-test odds X likelihood ratio 0.3333 X 4.8 = 1.5998 Post-test probability = post-test