Predictive Value of Diagnostic Tests

Sensitivity is the proportion of patients with disease who test positive. Sensitivity = True Positives/True Positives PLUS False Negatives

Specificity is the proportion of patients without disease who test negative. Specificity = True Negatives/True negatives Plus False Positives

Positive Predictive Value is the probability the person with a positive test result actually has the disease being tested for. PPV = True
Positives/True Positives +False Positives

Negative Predictive Value is the probability the person with a negative test result does not have the disease being tested for. NPV = True
Negative/False Negative +True Negative

Sample 2X2 table. Test sensitivity is 98%. Test specificity is 95%. Prevalence of disease is 1 in 100. 10,000 people are screened with the test.
disease no disease

test + 98 492

test - 2 9408

The positive predictive value (PPV) is 98/(98+492) = 16.6%. Even though the screening test has a sensitivity of 98%, a patient with a positive
test result in this low prevalence population has only a 16.6% chance of having the disease.

Some commonly used screening tests have poorer test characteristics than this example. For example, PSA for prostate cancer screening has the
following test characteristics, depending upon the cutoff for a positive test:

Cut-off 3.1 ng/mL; sensitivity 32.2% and specificity 86.7%

Cut-off 1.1 ng/mL; sensitivity 83.4% and specificity 38.9%

It is important to understand the characteristics of studies you order to better interpret what the results really mean.
Prevention of Embolism
More than 95% of pulmonary emboli arise from thrombi in the deep venous system of the lower extremities. Ninety percent of deaths due to
pulmonary embolism result within an hour or two—before diagnostic and therapeutic plans can be implemented. Therefore, prevention and
prompt treatment of DVT is the most effective approach to prevent embolism and death due to PE.
Parenteral Agents
There are three parenteral therapies used to either bridge with warfarin or pretreat prior to initiation of dabigatran: unfractionated heparin, low-
molecular weight heparin (LMWH), and fondaparinux.
Inherited Thrombophilias
Inherited thrombophilias, especially Factor V Leiden mutation, are not uncommon conditions in some populations, and may significantly
increase the risk of thrombosis in combination with clinical risk factors such as hormonal therapy (e.g. oral contraception, hormone replacement
therapy), immobility or intravascular catheters.