Key Teaching Points

High-Value Care Module B.

Statistics and Clinical Decision-Making

Sensitivity Proportion of patients with the disease who test positive

Specificity Proportion of patients without the disease who test negative

The likelihood that a given test result would be expected in a patient with the target
Positive likelihood
disorder compared to the likelihood that that same result would be expected in a
ratio (LR+)
patient without the target disorder
Negative The likelihood that a given test result would be expected in a patient without the
likelihood ratio target disorder compared to the likelihood that that same result would be expected in a
(LR-) patient with the target disorder

Pre-test
Probability that patient has disease before performing a diagnostic test
probability
Post-test
Probability that patient has disease after performing a diagnostic test
probability

Treatment
The clinicians required confidence in a diagnosis before instituting treatment
threshold

Using likelihood ratios to calculate the probability of disease

Nomograms and post-test probability calculators work across the entire range of probabilities.
For pre-test probability between 10% and 90%, use the quick calculation method:

Likelihood ratio Probability of disease

2 Increased by 15%
5 Increased by 30%
10 Increased by 45%
1/2 = 0.5 Decreased by 15%
1/5 = 0.2 Decreased by 30%
1/10 = 0.1 Decreased by 45%

1. Use a tests likelihood ratios to change your confidence in a particular diagnosis, which can then
make you more or less likely to treat a particular condition.

High-value tests help you decide on a treatment plan; low-value tests do not inform your treatment
plan
Depending on the pre-test probability of disease, an identical test can be high or low value.

2. Use likelihood ratios to choose tests which will help you cross the treatment threshold.

Before ordering a test, consider what the post-test probability of disease will be if the result is
positive or negative.
If the treatment threshold is not crossed, then you may want to choose a different test.