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This document discusses the importance of clinical examination in making accurate diagnoses and discusses key metrics used to evaluate clinical tests and signs such as sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios. It provides examples of calculating these metrics for tests to diagnose ascites and alcohol abuse. Clinical examinations are important but using metrics like sensitivity and specificity can help determine which signs and tests are most informative for a given condition.
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A 57-year-old man presents with progressively worsening low back pain, numbness in his right buttock and thigh, and weakness in his right lower limb. His temperature is elevated and he has tenderness in his lower back and decreased sensation in his right foot. The doctor suspects a 20% chance of spinal malignancy. While an MRI has higher sensitivity and specificity for diagnosis, the doctor considers whether to do an ESR or directly order an MRI. Using a 2x2 table method with the sensitivity and specificity of ESR, the doctor calculates that a positive ESR would increase the probability of malignancy from 20% to 37%.
Screening for diseases.pptx
Screening is a process by which we identify the people who have the disease from those who don't have the disease by using specific tests.
It's helps in identifying the disease even before the pre symptomatic period.
It can eliminate the disease my early diagnosis or decrease the damage it causes to one person's health by early treatment .
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2) For blunt trauma in unstable patients, the priorities are to assess for peritonitis and perform focused assessment with sonography for trauma (FAST) or diagnostic peritoneal aspiration (DPA) to detect fluid in the abdomen.
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- 1. RATIONAL OF CLINICAL EXAMINATION A Primer on the Precision and Accuracy of the Clinical Examination Sujan Kafle MDGP resident 1st year
- 2. • A patient is scheduled for orthopaedic surgery in 30 minutes , you stop by to see him. He is alert and hemodynamically stable but you noticed that he smells of alcohol and he has three spider nevi on his upper chest. • DOES HE HAVE ASCITIES? • IS THIS MAN AN ALCOHOLIC? • ARE THESE QUESTIONS IMPORTANT?
- 3. Investigations Alcohol dependence Ascities • Complete history taking • Liver function test • Platelete enzyme activity • CAGE question • Abdominal examination • Abdominal ultrasonography • History of ankle swelling WHICH ONE DO WE CHOOSE????
- 4. Tools • Sensitivity • Specificity • Positive predictive value • Negative predictive value • Likelihood ratio
- 6. Sensitivity It is a useful measure of how well a diagnostic test (whether a symptom, sign, or laboratory test) detects a target disorder when it is present. The closer the sensitivity to 100%, the more “sensitive” the clinical or laboratory finding. a/(a+c)
- 7. Specificity It is a useful measure of how often a symptom, sign, or other diagnostic test is absent when the target disorder is not present. The closer the specificity to 100%, the more “specific” the clinical or laboratory finding. • d/(b+d)
- 8. Pretest probability • Estimate of patients having the disease before conducting the test. • (a+c)/(a+b+c+d)
- 9. Positive predictive value • The ratio of patients truly diagnosed as positive to all those who had positive test results • Post test probability of having the target disorder. • a/(a+b)
- 10. Negative predictive value • The ratio of patients truly have negative test to all those who had negative test results • Post test probability of not having the target disorder • d/(c+d)
- 11. Calculate sensitivity, specificity, positive and negative predictive value from the following? Disease present Disease absent Test positive 900 100 1000 Test negative 100 900 1000 1000 1000 2000
- 13. Presence of ascities on abdominal ultrasonography History Of Ankle swelling Present Absent Yes 14 16 30 No 1 32 33 15 48 63
- 14. • Sensitivity 93% • Specificity 67% • Pretest probability 24% • Positive predictive value 47% • Negative predictive value 97%
- 15. Likelihood ratio: • Expression of sensitivity and specificity that can be used to estimate the odds that a condition is present or not
- 16. Advantages 1 Generates the post test odds for the disorder from the pretest odds • Pretest odd= (probability of having the target disorder)/(probability of not having the target disorder) • Pretest odds * likelihood ratio= posttest odds • Post test probability= (post test odds)/(post test odds +1) • CAN BE EASILY CALCULATED BY NOMOGRAM!!!
- 18. positive negative Likelihood ratio a x (a/Tpositive)/(x/Tnegative) b y (b/Tpositive)/(y/Tnegative) c z (c/Tpositive)/(z/Tnegative) Tpositive Tnegative
- 20. ALCOHOLABUSE OR DEPENDENCY Answer to the CAGE Questions Yes No 3 or 4 60 1 61 2,1 or none 57 400 457 117 401 518
- 21. ALCOHOL ABUSE OR DEPENDENCY Answer to the CAGE Question s Yes No 3 or 4 60 1 61 2,1 or none 57 400 457 117 401 518
- 22. • Sensitivity 51% • Specificity 99.8% • Pretest probability 23% • Positive predictive value 98% • Negative predictive value 88%
- 23. • Positive likelihood ratio 51 • Negative likelihood ratio 0.49
- 24. THANK YOU
Editor's Notes
- how able is surveillance to detect the health problem that it is intended to detect.
- How much it is able to
- Odds of having