Advertisement

Expected Value of Clinical Information: A Revisionist View

  • J. Robert Beck
  • David J. Malenka

Abstract

One of the commonest decisions in medicine is whether to order a diagnostic test. The speciality of laboratory medicine is particularly interested in this decision, and astute clinical pathologists offer consultative advice about the appropriate selection and sequencing of diagnostic tests. Inasmuch as tests should increase the probability of making correct diagnoses, pathologists’ advice should hinge on understanding the utility of testing as compared to other medical management options.

Keywords

Prior Probability Bayesian Analysis Threshold Model Transferrin Saturation Diagnostic Test Result 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    H. Raiffa, “Decision Analysis: Introductory Lectures on Choices Under Uncertainty”, Addison-Wesley, Reading MA (1968).Google Scholar
  2. 2.
    R. Fuhrer, The expected value, of clinical information, Bull. Cancer 67: 405 (1980).PubMedGoogle Scholar
  3. 3.
    M.C. Weinstein and H.V. Fineberg, “Clinical Decision Analysis”, W.B. Saunders, Philadelphia (1980).Google Scholar
  4. 4.
    T.J. Vecchio, Predictive value of a diagnostic test in unselected populations, New Engl. J. Med. 274: 1171 (1966).PubMedCrossRefGoogle Scholar
  5. 5.
    J.R. Beck, H.L. Bonkovsky, R.A. Cimis, et al., Non-invasive tests for suspected hemochromatosis: Multivariate and decision analyses, Clin. Res. 33: 242A (1985).Google Scholar
  6. 6.
    R.D. Aach, W. Szmuness, J.W. Moseley, et al., Serum alanine aminotransferase of donors in relation to the risk of non-A, non-B hepatitis in recipients: The Transfusion-Transmitted Viruses Study, New Engl. J. Med. 304: 989 (1981).PubMedCrossRefGoogle Scholar
  7. 7.
    A.F. Krieg and J.R. Beck, Evaluating diagnostic performance of tests by spreadsheet modeling, Arch. Pathol. Lab. Med., in press.Google Scholar
  8. 8.
    R.A. Greenes, Interactive microcomputer-based graphical tools for physician decision support: Aids to test selection and interpretation and use of Bayes’ theorem, Med. Decis. Making 3: 15 (1983).PubMedCrossRefGoogle Scholar
  9. 9.
    S.G. Pauker and J.P. Kassirer, The threshold approach to clinical decision making, New Engl. J. Med. 302: 1109 (1980).Google Scholar
  10. 10.
    J.R. Beck, Laboratory decision science applied to chemometrics: Strategic testing of thyroid function, Clin. Chem. 32: 1707 (1986).PubMedGoogle Scholar
  11. 11.
    A.F. Krieg, T.W. Abendroth and M.B. Bongiovanni, When is a diagnostic test result positive? Decision tree models based on net utility and threshold, Arch. Pathol. Lab. Med. 110:787 (1986).PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1988

Authors and Affiliations

  • J. Robert Beck
    • 1
  • David J. Malenka
    • 2
  1. 1.Depts. Pathol.Community and Family Med.HanoverUSA
  2. 2.Med. Program in Med. Information Sci., Dartmouth-Hitchcock Med. CenterHanoverUSA

Personalised recommendations