Diagnostic test

Let's consider that we want to see whether a number of patient are having a certain disease or not , when patient is having the disease we call it present, when

the patient is not having the disease we call it absent , also we have a test for this disease , when the patient responds positively this means that he have the disease , and when the patient responds negatively this means that he doesnt have the disease

if the test was

100% accurate , unfortunately no test is 100% accurate all the time we have some exceptions ,and for this reason we have what we call false positive , false negative test results ,,look at this table

DISEASE Present TEST Positive True positive If the test is positive and the disease is present False negativeIf the test is negative and the disease is present Absent False positive If the test is positive and the disease is absent True negativeIf the test is negative and the disease is absent
# of people with a positive test result

Negative

# of people with a negative test result

# of people with the disease

# of people without the disease

(positive, negative )describes the test result , and (true ,false) describes the accuracy of the test(correct or not) ,, for example when we say false positive what does this mean? False positive

postive means that the test result indicates the presence of the dieseas

false maens that the test is not correct, and a false test result we got

blmo79ellh the patiant doesn't have the disease and the test result was wrong

Sensitivity The proportion of people who tested positive for the disease from those who have the disease true positive =presence of the =true positive /( true positive +false negative )
disease with a correct positive test

High sensitive test will rarely miss people with false negative =presence of The disease , because in high sensitive tests the disease with incorrect There is a high number of negative result) people who have the disease and an accurate positive test result compared to those who have the disease with wrong positive result. Use of sensitive tests

 In case of important penalty of missing a condition (dangerous but treatable condition) Tuberculosis, syphilis, Hodgkin's disease During early stage of diagnostic workup with many possibilities to be considered in order to reduce the number of those possibilities Fever, anemia, nausea To rule out diseases with a negative result of a highly sensitive test Highly sensitive HIV ab test early in evaluation of lung infiltrates &wt loss to rule out AIDS-related infection When the probability of disease is very low and the purpose of test is to discover the disease *In summary: useful when test result is negative and we dont want false negative(the patient have the disease but the test was incorrect) results

Specificity: The proportion of people who tested negative for the disease from those without the disease = True negative / (true negative +false negative) High specific test will rarely miss people without the disease Use of specific test Useful to confirm a diagnosis Incases when false positive results will harm the patient emotionally, physically and financially

 E.g., cancer, I dont want to tell a person that he have a cancer and after all I figure out the test wasn t correct , its not ethical *In summary: useful when test result is positive and we dont want false positive(the patient doesnt have the disease but the test was incorrect )results

Prevalence The proportion of people who have the disease to the total number (I dont care whether the test was correct or not ) = true positive false negative / total #

Relationship between sensitivity & specificity of diagnostic tests

Disease

Present

Absent

a
Positive True positive

b
False positive

Test

c
Negative False negative

d
True negative

Sensitivity (Se) = a/a+c

Specificity (Sp)= d/b+d

Prevalence (P) = a+c/a+b+c+d

Example: 37 of 149 patients with sore throats were diagnosed as having pharyngitis and receive Antibiotics true positive +false negative = 37 Only 27 of those had positive culture for streptococcus true positive =27 The remaining 112 with sore throats were not diagnosed as having pharyngitis and were not given Antibiotics false positive +true negative =112 Of the those 112, 77 had negative cultures for streptococcus true negative=77

Streptococcus Cultures (Disease) Present Doctors clinical examinations (Test) Positive Negative 27 *10
37

Absent *35 77
112

Those # with stars u have to calculate them

Sensitivity= a/a+c = 27/27+10 = 27/37 = 73% Specificity= d/b+d = 77/35+77 = 77/112=69% Prevalence= a+c/a+b+c+d = 37/149 = 25%

 Predictive value Sensitivity and specificity are obtained in persons known to have or not have the disease Predictive value of the test Is the probability of disease, given the results of a test Positive predictive value Is the probability of disease in a patient with a positive (abnormal) test result(concerned with people who have a positive test result ) =true positive /(true positive+ false positive) If my patients test is positive, what are the chances that my patient does have the disease? Answer: positive predictive value

Negative predictive value Is the probability of not having the disease when the test result is negative (normal).(concerned with people who have a negative test result ) =true negative /(true negative +false negative) If my patients test is negative, what are the chances that my patient does not have the disease? Answer: negative predictive value Accuracy Accuracy summarize the overall value of a test

 Accuracyis the proportion of all test results, both positive and negative, that are correct Accuracy = true positive +true negative / total number

Prevalence (P) = a+c/a+b+c+d

Relationship between sensitivity & specificity of diagnostic tests

Disease

Present

Absent

a Positive Accuracy = a+d / a+b+c+d Test c Negative False negative True positive

b False positive d True negative

- Predictive Value =d/c+d + Predictive Value =a/a+b

Sensiti vity (Se) = a/a+c

Specifi city (Sp)= d/b+d

Question#1 ????? I examined 100 patient for the presence of pulpitis using cold pulp test Those who have the disease present =70 ,,,55 of them have a positive test Those who have the disease absente = 30 Those who have a positive test =60 Those who have a negative test =40 Find sensitivity , specificity, +predictive value,-predictive value, accuracy and prevalence ??? First : fill the table with the correct number
COLD PULP TEST If we apply a cold stimulus on affected tooth ,the result will be positive if it responds by pain prolongs for more than one minute , negative if its not

pulpitis (Disease) Present Positive Negative Absent

total

Cold pulp test (Test) total

sensitivity= specificity= +predictive value= -predective value= Accuracy= Prevalence= Check out your answers in the last pageS

 Sensitivity & Specificity & PV The more sensitive a test is, the better will be its negative predictive value Streptococcus Cultures (Disease) Present Absent Doctors clinical examinations (Test) Sensitivity = 37/37 = 100% + P V = 37/72 = 51% Specificity =77/112 = 69% - P V = 77/77 = 100% Positive Negative 37 0 35 77

The more specific the test is, the better will be its positive predictive value Streptococcus Cultures (Disease) Present Doctors clinical examinations (Test) Positive negative 27 10 Absent 0 112

Sensitivity = 27/37 = 73% + P V = 27/27 = 100%

Specificity =112/112 = 100% - P V = 112/122 = 92%

 Prevalence and PV As the prevalence of disease in a population approaches zero, the positive predictive value of a test also approaches zero

Streptococcus Cultures (Disease) Present Doctors clinical examinations (Test) Positive negative 3 1 Absent 45 100

Prevalence = 4/149 = 3% +Predictive Value = A / A + B = 3/48 = 6% -Predictive Value = D / C + D = 100/145 = 69%

As prevalence approaches 100%, negative predictive value approaches zero

Streptococcus Cultures (Disease) Present Doctors clinical examinations (Test) Positive negative 106 40 Absent 1 2

Prevalence = 146/149 = 98% +Predictive Value = A / A + B = 106/107 = 99% - Predictive Value = D / C + D = 2/42 = 5%

Q#2
In a research to study the prevalence of a gingivitis among 200 patient using gingivitis bleeding test , those who have a positive test result were 60 , among those 60 only 35 were really have the disease present , if you know that # of patient who have the disease absent= 75 calculate the following ??

First :Sensitivity ,specificity ,+predictive value, -predictive value, Accuracy, Prevalence Second : if I assume that the sensitivity approaches 100% which from the above value will be more affected ? and what is the effect ? third : if I assume that the specificity approaches 100% which from the above value will be more affected ? and what is the effect ? fourth : if I assume that the prevalence approaches 0 which from the above value will be more affected ? and what is the effect ?

answers

Q#1

pulpitis (Disease) Present Cold pulp test (Test) total Positive Negative 55 *15 70 Absent *5 *25 30

total

60 40

sensitivity =55/70 specificity=25/30 +predictive value=55/60 -predective value=25/40 Accuracy=(55+25)/100 Prevalence=70/100

Q#2

Gingivitis (Disease) Present Cold pulp test (Test) total sensitivity =35/125 specificity=50/75 +predictive value=35/60 -predictive value=50/140 Accuracy=35+50/200 Prevalence=125/200 Positive Negative 35 *90 *125 Absent *25 *50 75

total

60 *140 200

Second : if I assume that the sensitivity approaches 100% which from the above value will be more affected ? and what is the effect ? -predictive value , its value will approach 100% third : if I assume that the specificity approaches 100% which from the above value will be more affected ? and what is the effect ? +predictive value , its value will approach 100%

fourth : if I assume that the prevalence approaches 0 which from the above value will be more affected ? and what is the effect +predictive value , its value will approach 0

Thats all for this lecture , hope it's clear ,forgive for any mistake or u just "3'6rsho :D" the quiz will be on Saturday 14th of this month ,from 12pm to 12am in this lecture only , good luck

DoNe By : M.F.GhArAiBeH
Dana Al-Shboul didnt review, verify, correct, nor fix the SCRIPT, However her big EFFORT is always appreciable :D ,she wishes you the best of luck. :D :D :D :D