診断の確実性への道には,利回りが減っている
1Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, NY.
JAMA
|May 1, 1991
まとめ
診断検査は,誤った達成感を与えることがあります. 診断の確実性が高まるにつれ,検査から得られる有用な情報は,正確な結果であっても,ゼロに近づく.
科学分野:
- 医療診断 医療診断
- 臨床的意思決定について
- 医学における情報理論
背景:
- 診断検査は,臨床的意思決定において極めて重要です.
- 高い感度と特異性は,常に診断の有用性を保証するものではありません.
- 診断の確実性という概念は,誤解を招くことがあります.
研究 の 目的:
- 診断検査の情報価値を分析する.
- 診断の確実性と検査情報との関係を調査する.
- 確実性が高まるにつれ,診断情報はどのように減っていくかを示す.
主な方法:
- 診断検査から得られる有用な情報を計算する.
- 定義された臨床環境における分析.
- 診断の確実性へのアプローチをモデリングする.
主要な成果:
- 敏感で特異的な検査は,最低限の診断情報しか得られない.
- 診断の確実性が高まるにつれて,有用な情報の量はゼロに近づく.
- 診断の確実性は,誤った達成感を生み出します.
結論:
- 診断検査の臨床的有用性は,文脈に依存しています.
- 情報理論は,診断テストの評価のための枠組みを提供します.
- テスト前確率を考慮せずにテスト結果に過度に依存することは問題となる可能性があります.
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