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A Randomized Trial of Interval Likelihood Ratios for Clinical Decision-Making.
Maksym Goryachok1, Jintong Liu1, Tyler Benjamin1
1University of Colorado School of Medicine, Aurora, CO, USA.
NEJM Evidence
|June 23, 2026
Summary
Interval Likelihood Ratios (ILRs) significantly improved clinical decision-making compared to traditional single-threshold and binary formats. Presenting diagnostic test information with ILRs enhanced accuracy in simulated patient cases.
Area of Science:
- Medical Decision Making
- Diagnostic Test Evaluation
- Clinical Informatics
Background:
- Traditional dichotomized reporting of diagnostic test results can oversimplify test characteristics.
- Interval Likelihood Ratios (ILRs) offer a more nuanced approach by presenting test characteristics across a range of values.
- The impact of ILRs on clinical decision-making remains uncertain.
Purpose of the Study:
- To assess whether Interval Likelihood Ratios (ILRs) improve clinical decisions compared to single-threshold and binary test characteristic presentations.
- To evaluate the impact of different diagnostic test result reporting formats on healthcare provider decision-making.
- To compare the efficacy of ILRs against traditional methods in simulated clinical scenarios.
Main Methods:
- A multicenter randomized trial involving internal medicine residents, attending physicians, and advanced practice providers.
- Participants were presented with two fictional vignettes (pulmonary embolism diagnosis and heart failure treatment) with identical cases.
- Vignettes varied only in the presentation of test characteristics: single threshold, binary, or ILRs.
Main Results:
- The correct decision rate was significantly higher with ILRs (93.4%) compared to the threshold group (82.2%) and binary group (75.1%).
- Improvements were observed in both pulmonary embolism and heart failure case vignettes, with varying magnitudes.
- The ILR group demonstrated a 11.2 and 18.3 percentage point increase in correct decisions over threshold and binary groups, respectively.
Conclusions:
- Presenting diagnostic test information using Interval Likelihood Ratios (ILRs) demonstrably improves vignette-based clinical decisions.
- The effectiveness of ILRs may vary depending on the specific clinical case vignette.
- ILRs represent a valuable tool for enhancing diagnostic reasoning and clinical management.
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