Pretest expectations strongly influence interpretation of abnormal laboratory results and further management
<p>Abstract</p> <p>Background</p> <p>Abnormal results of diagnostic laboratory tests can be difficult to interpret when disease probability is very low. Although most physicians generally do not use Bayesian calculations to interpret abnormal results, their estimates of...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2010-02-01
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| Series: | BMC Family Practice |
| Online Access: | http://www.biomedcentral.com/1471-2296/11/13 |
| _version_ | 1818117809536761856 |
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| author | Winkens Ron AG Winkens Bjorn van der Weijden Trudy Houben Paul HH Grol Richard PTM |
| author_facet | Winkens Ron AG Winkens Bjorn van der Weijden Trudy Houben Paul HH Grol Richard PTM |
| author_sort | Winkens Ron AG |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Abnormal results of diagnostic laboratory tests can be difficult to interpret when disease probability is very low. Although most physicians generally do not use Bayesian calculations to interpret abnormal results, their estimates of pretest disease probability and reasons for ordering diagnostic tests may - in a more implicit manner - influence test interpretation and further management. A better understanding of this influence may help to improve test interpretation and management. Therefore, the objective of this study was to examine the influence of physicians' pretest disease probability estimates, and their reasons for ordering diagnostic tests, on test result interpretation, posttest probability estimates and further management.</p> <p>Methods</p> <p>Prospective study among 87 primary care physicians in the Netherlands who each ordered laboratory tests for 25 patients. They recorded their reasons for ordering the tests (to exclude or confirm disease or to reassure patients) and their pretest disease probability estimates. Upon receiving the results they recorded how they interpreted the tests, their posttest probability estimates and further management. Logistic regression was used to analyse whether the pretest probability and the reasons for ordering tests influenced the interpretation, the posttest probability estimates and the decisions on further management.</p> <p>Results</p> <p>The physicians ordered tests for diagnostic purposes for 1253 patients; 742 patients had an abnormal result (64%). Physicians' pretest probability estimates and their reasons for ordering diagnostic tests influenced test interpretation, posttest probability estimates and further management. Abnormal results of tests ordered for reasons of reassurance were significantly more likely to be interpreted as normal (65.8%) compared to tests ordered to confirm a diagnosis or exclude a disease (27.7% and 50.9%, respectively). The odds for abnormal results to be interpreted as normal were much lower when the physician estimated a high pretest disease probability, compared to a low pretest probability estimate (OR = 0.18, 95% CI = 0.07-0.52, p < 0.001).</p> <p>Conclusions</p> <p>Interpretation and management of abnormal test results were strongly influenced by physicians' estimation of pretest disease probability and by the reason for ordering the test. By relating abnormal laboratory results to their pretest expectations, physicians may seek a balance between over- and under-reacting to laboratory test results.</p> |
| first_indexed | 2024-12-11T04:44:19Z |
| format | Article |
| id | doaj.art-441b59608ddd417bb09dd2e74b6ad507 |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-12-11T04:44:19Z |
| publishDate | 2010-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-441b59608ddd417bb09dd2e74b6ad5072022-12-22T01:20:32ZengBMCBMC Family Practice1471-22962010-02-011111310.1186/1471-2296-11-13Pretest expectations strongly influence interpretation of abnormal laboratory results and further managementWinkens Ron AGWinkens Bjornvan der Weijden TrudyHouben Paul HHGrol Richard PTM<p>Abstract</p> <p>Background</p> <p>Abnormal results of diagnostic laboratory tests can be difficult to interpret when disease probability is very low. Although most physicians generally do not use Bayesian calculations to interpret abnormal results, their estimates of pretest disease probability and reasons for ordering diagnostic tests may - in a more implicit manner - influence test interpretation and further management. A better understanding of this influence may help to improve test interpretation and management. Therefore, the objective of this study was to examine the influence of physicians' pretest disease probability estimates, and their reasons for ordering diagnostic tests, on test result interpretation, posttest probability estimates and further management.</p> <p>Methods</p> <p>Prospective study among 87 primary care physicians in the Netherlands who each ordered laboratory tests for 25 patients. They recorded their reasons for ordering the tests (to exclude or confirm disease or to reassure patients) and their pretest disease probability estimates. Upon receiving the results they recorded how they interpreted the tests, their posttest probability estimates and further management. Logistic regression was used to analyse whether the pretest probability and the reasons for ordering tests influenced the interpretation, the posttest probability estimates and the decisions on further management.</p> <p>Results</p> <p>The physicians ordered tests for diagnostic purposes for 1253 patients; 742 patients had an abnormal result (64%). Physicians' pretest probability estimates and their reasons for ordering diagnostic tests influenced test interpretation, posttest probability estimates and further management. Abnormal results of tests ordered for reasons of reassurance were significantly more likely to be interpreted as normal (65.8%) compared to tests ordered to confirm a diagnosis or exclude a disease (27.7% and 50.9%, respectively). The odds for abnormal results to be interpreted as normal were much lower when the physician estimated a high pretest disease probability, compared to a low pretest probability estimate (OR = 0.18, 95% CI = 0.07-0.52, p < 0.001).</p> <p>Conclusions</p> <p>Interpretation and management of abnormal test results were strongly influenced by physicians' estimation of pretest disease probability and by the reason for ordering the test. By relating abnormal laboratory results to their pretest expectations, physicians may seek a balance between over- and under-reacting to laboratory test results.</p>http://www.biomedcentral.com/1471-2296/11/13 |
| spellingShingle | Winkens Ron AG Winkens Bjorn van der Weijden Trudy Houben Paul HH Grol Richard PTM Pretest expectations strongly influence interpretation of abnormal laboratory results and further management BMC Family Practice |
| title | Pretest expectations strongly influence interpretation of abnormal laboratory results and further management |
| title_full | Pretest expectations strongly influence interpretation of abnormal laboratory results and further management |
| title_fullStr | Pretest expectations strongly influence interpretation of abnormal laboratory results and further management |
| title_full_unstemmed | Pretest expectations strongly influence interpretation of abnormal laboratory results and further management |
| title_short | Pretest expectations strongly influence interpretation of abnormal laboratory results and further management |
| title_sort | pretest expectations strongly influence interpretation of abnormal laboratory results and further management |
| url | http://www.biomedcentral.com/1471-2296/11/13 |
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