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  • 1.  Diagnosis in practice

    Posted 08-09-2021 11:42
    I have been impressed by the fact that physicians everywhere diagnose a disease from a highly informative test result with likelihood ratio (LR) greater than 10 with a high degree of confidence in the high accuracy of this diagnosis in any patient in whom this disease is suspected regardless of its prior probability. Some examples are diagnosis of pulmonary embolism from positive chest CT angiogram, LR 20; diagnosis of acute myocardial infarction from acute ST elevation EKG changes, LR 13; diagnosis of deep vein thrombosis from positive venous ultrasound study, LR 16 and diagnosis of covid-19 disease from positive covid-19 PCR test, LR 14. Has anyone found any exception to diagnosis of any of these diseases in this manner? For example, has anyone not diagnosed acute myocardial infarction in a patient with low prior probability in whom it was suspected and acute ST elevation EKG changes observed?


    Bimal Jain MD
    Mass General Brigham/Salem Hospital
    Salem MA 01970.
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