Quantitative information of specific diagnostic tests. 1998

A F Bowyer
East Carolina Heart Institute, Inc., Greenville, NC 27834, USA.

The goal of diagnostic testing is to maximize information (I) of a specific disease of interest (D) resulting from the performance of a specific diagnostic test procedure (T). However, all tests suffer from errors which result in incomplete information and inaccurate diagnostic conclusions. The methods of Information Theory have successfully solved a range of signal transmission problems involving physical systems operating under conditions of noise. Medical testing procedures were found to be analogous to noisy systems; hence, Information Theory methods were applied to minimize errors in diagnostic testing. Prior to performing a diagnostic test, the quantity of information, Apriori Information (ID), regarding the presence or absence of the disease was only a function of the prevalence (P) of disease in the population. After performing a diagnostic test, the quantity of information, Aposteriori Information (IDIT) was a function of not only P but also the test sensitivity (A) and test specificity (B). The quantity of information gained by test performance was computed from the difference between aposteriori and apriori information. delta I = IDIT - ID To illustrate the relationship between pretest, apriori, and post-test, aposteriori, information the values of ID and IDIT were computed for five common cardiovascular tests applied to populations with different coronary artery disease prevalence. This cross-sectional analysis studied the quantitative information obtained from Electrocardiography (ECG), Bicycle Ergometer Stress Tests (BEST), Stress-Echo Ergometer Tests (SEET), Thallium 201 Stress Tests (ThST), and Coronary Arteriography (CorA). Apriori information ranged from a minimum of 0 (for prevalence = 0.5) to a maximum of 1.0 (for prevalence = 0 or 1.0) The aposteriori information was computed for all apriori information and occupied the range between that of a "perfect" test (A = 1.0 and B = 1.0) and that of a "worthless" test (A = 0.5 and B = 0.5). All tests demonstrated greater information gain when apriori information was minimal; Little additional information could be gained when the apriori information was close to certainty (i.e., for prevalence near 0 or 1.0). Electrocardiography demonstrated little significant IDIT at any value of ID. Thallium 201 stress tests provided similar aposteriori information values to those of Stress-Echo Ergometer Stress and either demonstrated greater information gain than Bicycle Ergometer Stress Tests. Coronary Arteriography provided the maximum values of aposteriori information. Information Theory methods provided an effective quantitative method to compare the effectiveness of diagnostic tests over a wide range of disease prevalence.

UI MeSH Term Description Entries
D007257 Information Theory An interdisciplinary study dealing with the transmission of messages or signals, or the communication of information. Information theory does not directly deal with meaning or content, but with physical representations that have meaning or content. It overlaps considerably with communication theory and CYBERNETICS. Information Theories,Theories, Information,Theory, Information
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D008962 Models, Theoretical Theoretical representations that simulate the behavior or activity of systems, processes, or phenomena. They include the use of mathematical equations, computers, and other electronic equipment. Experimental Model,Experimental Models,Mathematical Model,Model, Experimental,Models (Theoretical),Models, Experimental,Models, Theoretic,Theoretical Study,Mathematical Models,Model (Theoretical),Model, Mathematical,Model, Theoretical,Models, Mathematical,Studies, Theoretical,Study, Theoretical,Theoretical Model,Theoretical Models,Theoretical Studies
D003327 Coronary Disease An imbalance between myocardial functional requirements and the capacity of the CORONARY VESSELS to supply sufficient blood flow. It is a form of MYOCARDIAL ISCHEMIA (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. Coronary Heart Disease,Coronary Diseases,Coronary Heart Diseases,Disease, Coronary,Disease, Coronary Heart,Diseases, Coronary,Diseases, Coronary Heart,Heart Disease, Coronary,Heart Diseases, Coronary
D003430 Cross-Sectional Studies Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time. Disease Frequency Surveys,Prevalence Studies,Analysis, Cross-Sectional,Cross Sectional Analysis,Cross-Sectional Survey,Surveys, Disease Frequency,Analyses, Cross Sectional,Analyses, Cross-Sectional,Analysis, Cross Sectional,Cross Sectional Analyses,Cross Sectional Studies,Cross Sectional Survey,Cross-Sectional Analyses,Cross-Sectional Analysis,Cross-Sectional Study,Cross-Sectional Surveys,Disease Frequency Survey,Prevalence Study,Studies, Cross-Sectional,Studies, Prevalence,Study, Cross-Sectional,Study, Prevalence,Survey, Cross-Sectional,Survey, Disease Frequency,Surveys, Cross-Sectional
D003935 Diagnostic Techniques, Cardiovascular Methods and procedures for the diagnosis of diseases or dysfunction of the cardiovascular system or its organs or demonstration of their physiological processes. Cardiovascular Diagnostic Technic,Cardiovascular Diagnostic Technics,Cardiovascular Diagnostic Technique,Cardiovascular Diagnostic Techniques,Diagnostic Technic, Cardiovascular,Diagnostic Technics, Cardiovascular,Diagnostic Technique, Cardiovascular,Technic, Cardiovascular Diagnostic,Technics, Cardiovascular Diagnostic,Technique, Cardiovascular Diagnostic,Techniques, Cardiovascular Diagnostic
D004452 Echocardiography Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. Echocardiography, Contrast,Echocardiography, Cross-Sectional,Echocardiography, M-Mode,Echocardiography, Transthoracic,Echocardiography, Two-Dimensional,Transthoracic Echocardiography,2-D Echocardiography,2D Echocardiography,Contrast Echocardiography,Cross-Sectional Echocardiography,Echocardiography, 2-D,Echocardiography, 2D,M-Mode Echocardiography,Two-Dimensional Echocardiography,2 D Echocardiography,Cross Sectional Echocardiography,Echocardiography, 2 D,Echocardiography, Cross Sectional,Echocardiography, M Mode,Echocardiography, Two Dimensional,M Mode Echocardiography,Two Dimensional Echocardiography
D004562 Electrocardiography Recording of the moment-to-moment electromotive forces of the HEART as projected onto various sites on the body's surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a CATHODE RAY TUBE DISPLAY. 12-Lead ECG,12-Lead EKG,12-Lead Electrocardiography,Cardiography,ECG,EKG,Electrocardiogram,Electrocardiograph,12 Lead ECG,12 Lead EKG,12 Lead Electrocardiography,12-Lead ECGs,12-Lead EKGs,12-Lead Electrocardiographies,Cardiographies,ECG, 12-Lead,EKG, 12-Lead,Electrocardiograms,Electrocardiographies, 12-Lead,Electrocardiographs,Electrocardiography, 12-Lead
D005080 Exercise Test Controlled physical activity which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. Arm Ergometry Test,Bicycle Ergometry Test,Cardiopulmonary Exercise Testing,Exercise Testing,Step Test,Stress Test,Treadmill Test,Cardiopulmonary Exercise Test,EuroFit Tests,Eurofit Test Battery,European Fitness Testing Battery,Fitness Testing,Physical Fitness Testing,Arm Ergometry Tests,Bicycle Ergometry Tests,Cardiopulmonary Exercise Tests,Ergometry Test, Arm,Ergometry Test, Bicycle,Ergometry Tests, Arm,Ergometry Tests, Bicycle,EuroFit Test,Eurofit Test Batteries,Exercise Test, Cardiopulmonary,Exercise Testing, Cardiopulmonary,Exercise Tests,Exercise Tests, Cardiopulmonary,Fitness Testing, Physical,Fitness Testings,Step Tests,Stress Tests,Test Battery, Eurofit,Test, Arm Ergometry,Test, Bicycle Ergometry,Test, Cardiopulmonary Exercise,Test, EuroFit,Test, Exercise,Test, Step,Test, Stress,Test, Treadmill,Testing, Cardiopulmonary Exercise,Testing, Exercise,Testing, Fitness,Testing, Physical Fitness,Tests, Arm Ergometry,Tests, Bicycle Ergometry,Tests, Cardiopulmonary Exercise,Tests, EuroFit,Tests, Exercise,Tests, Step,Tests, Stress,Tests, Treadmill,Treadmill Tests

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