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Improved accuracy when screening for human growth disorders by likelihood ratios.
1TNO Quality of Life, P.O. Box 2215, 2301 CE Leiden, The Netherlands. Stef.vanBuuren@tno.nl
Statistics in Medicine
|August 22, 2007
Summary
Likelihood ratio (LR) rules outperform standard deviation score (SDS) rules for identifying growth disorders. LR provides a more accurate assessment of disease probability in children compared to SDS screening.
Area of Science:
- Pediatrics
- Medical Statistics
- Genetics
Background:
- Standard deviation score (SDS) is commonly used for screening growth-related problems.
- Current referral rules based on SDS are not optimal for differentiating reference from diseased populations.
- The likelihood ratio (LR) and log-likelihood ratio (LLR) offer a theoretically superior approach when disease-specific growth standards are known.
Purpose of the Study:
- To compare the diagnostic accuracy of likelihood ratio (LR) rules versus standard deviation score (SDS) rules for screening growth disorders.
- To evaluate the effectiveness of LR and SDS in distinguishing between a reference population and a diseased population.
Main Methods:
- Applied LR and SDS referral rules to longitudinal growth data from birth to 10 years.
- Compared Turner syndrome patient data against a healthy reference group.
- Calculated receiver operating characteristic (ROC) curves to assess test performance.
Main Results:
- LR rules demonstrated superior sensitivity and specificity compared to SDS rules.
- Empirical data confirmed theoretical predictions regarding the power of LR tests.
- LLR rules were identified as uniformly the most powerful statistical test for this purpose.
Conclusions:
- Likelihood ratio (LR) is the optimal measure for two-group comparative studies in growth assessment.
- LR can be readily calculated for individual measurements, providing an absolute probability of disease.
- LR offers a statistically robust and decision-theoretically sound method for diagnosing growth-related conditions.
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