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Refinar el diagnóstico clínico con las relaciones de probabilidad.

David A Grimes¹, Kenneth F Schulz

¹Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA. dgrimes@fhi.org

Lancet (London, England)

|April 27, 2005

Resumen

Las relaciones de probabilidad mejoran el diagnóstico clínico al comparar los resultados de las pruebas en individuos enfermos versus sanos. Estas proporciones, aunque subutilizadas, mejoran significativamente la precisión del diagnóstico cuando se combinan con la evaluación clínica.

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Área de la Ciencia:

Diagnóstico médico Diagnóstico médico
La toma de decisiones clínicas.

Sus antecedentes:

Los ratios de probabilidad (LR) son herramientas valiosas para refinar el diagnóstico clínico basado en signos y síntomas.
A pesar de su utilidad, los LR actualmente están subutilizados en la atención al paciente.
Los LR cuantifican el valor diagnóstico de una prueba comparando la proporción de pacientes enfermos con un resultado dado con pacientes sanos con el mismo resultado.

Objetivo del estudio:

Para resaltar la importancia y la aplicación de las relaciones de probabilidad en el diagnóstico clínico.
Para enfatizar cómo las relaciones de probabilidad pueden mejorar la precisión del diagnóstico.

Principales métodos:

Explicación del cálculo de la relación de probabilidad para las pruebas dicotómicas y de varios niveles.
Discusión de cómo los ratios de probabilidad influyen en los cambios de probabilidad de pre-prueba a post-prueba.

Principales resultados:

Los altos ratios de probabilidad indican que los resultados de las pruebas son más comunes en individuos enfermos.
Las bajas relaciones de probabilidad indican que los resultados de las pruebas son más comunes en individuos sanos.
Las relaciones de probabilidad cercanas a la unidad tienen un impacto mínimo en la probabilidad de diagnóstico.

Conclusiones:

Los ratios de probabilidad, particularmente altos o bajos, pueden alterar significativamente la estimación de probabilidad de enfermedad de un clínico.
La integración de los ratios de probabilidad de las pruebas auxiliares con un diagnóstico clínico preciso mejora sinérgicamente la precisión general del diagnóstico.