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Assessing diagnostic confidence: a comparative review of analytical methods
Chaan S Ng1, Christopher R Palmer
1Department of Radiology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA. cng@mdanderson.org
Academic Radiology
|April 22, 2008
Summary
Comparing diagnostic confidence methods, the score-based approach offers a more nuanced evaluation by considering diagnostic accuracy and misdiagnosis severity. While all methods showed computed tomography (CT) positively impacted confidence, the score-based method better addresses analytical limitations.
Area of Science:
- Medical Imaging and Diagnostics
- Clinical Decision Making
- Biostatistics
Background:
- Diagnostic confidence is a key measure of a medical test's efficacy.
- Evaluating changes in diagnostic confidence requires robust analytical methods.
- Existing methods have limitations in accounting for diagnostic accuracy and misdiagnosis severity.
Purpose of the Study:
- To compare five distinct analytic methods for evaluating changes in diagnostic confidence.
- To assess the performance of "basic," "retained diagnoses," "Omary," "Tsushima," and "score-based" methods.
- To illustrate method comparison using a clinical case study of abdominopelvic computed tomography (CT).
Main Methods:
- Utilized data from a clinical study on acute abdominal pain patients.
- Assessed changes in diagnostic confidence (0%-100%) before and after abdominopelvic CT.
- Compared five analytic approaches: basic, retained diagnoses, Omary, Tsushima, and score-based.
Main Results:
- All five methods indicated a positive contribution of CT to diagnostic confidence (P <= .003).
- The score-based method uniquely accounts for diagnostic accuracy and varying misdiagnosis impacts.
- In the case study, mean confidence increased from 50.7% to 73.2%; 43% of diagnoses changed post-CT.
Conclusions:
- Despite no consequential differences in the illustrative case, fundamental principles vary significantly among methods.
- The choice of analytic method for assessing diagnostic confidence should consider these underlying differences.
- The score-based method presents a more comprehensive approach to evaluating diagnostic test efficacy.
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