Factors affecting sensitivity and specificity of a diagnostic test: the exercise thallium scintigram

doi:10.1016/0002-9343(88)90107-6

The American Journal of Medicine

Volume 84, Issue 4, April 1988, Pages 699-710

https://doi.org/10.1016/0002-9343(88)90107-6 Get rights and content

Abstract

Technical and methodological factors might affect the reported accuracies of diagnostic tests. To assess their influence on the accuracy of exercise thallium scintigraphy, the medical literature (1977 to 1986) was non-selectively searched and meta-analysis was applied to the 56 publications thus retrieved. These were analyzed for year of publication, sex and mean age of patients, percentage of patients with angina pectoris, percentage of patients with prior myocardial infarction, percentage of patients taking beta-blocking medications, and for angio-graphic referral (workup) bias, blinding of tests, and technical factors. The percentage of patients with myocardial infarction had the highest correlation with sensitivity (0.45, p = 0.0007). Only the inclusion of subjects with prior infarction and the percentage of men in the study group were independently and significantly (p <0.05) related to test sensitivity. Both the presence of workup bias and publication year adversely affected specificity (p <0.05). Of these two factors, publication year had the strongest association by stepwise linear regression. This analysis suggests that the reported sensitivity of thallium scintigraphy is higher and the specificity lower than that expected in clinical practice because of the presence of workup bias and the inappropriate inclusion of post-infarct patients.

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^☆: Dr. Janosi is a National Institutes of Health Research Fellow in Cardiology from The Hungarian Institute of Cardiology, Budapest, Hungary.

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Factors affecting sensitivity and specificity of a diagnostic test: the exercise thallium scintigram☆

Abstract

Am J Cardiol

Am J Med

Am J Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am Heart J

J Am Coll Cardiol

Chest

Am Heart J

Am J Cardiol

Am J Cardiol

Semin Nucl Med

J Am Coll Cardiol

Am Heart J

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Beyond normality: the predictive value and efficiency of medical diagnoses

Rational diagnosis and treatment

Selection and interpretation of diagnostic tests and procedures

Ann Intern Med

Probability theory in the use of diagnostic tests

Problems of spectrum and bias in evaluating the efficacy of diagnostic tests

N Engl J Med

The limited spectrum of patients studied in exercise test research

Clinical prediction rules

Bayesian analysis versus discriminant function analysis: their relative utility in the diagnosis of coronary disease

Circulation

Meta-analysis in social research

Meta-analysis of randomized controlled trials

N Engl J Med

Differential effects of exercise on serum lipid and lipoprotein levels seen with changes in body weight

Les examens isotopiques a l'effort dans l'isuffisance coronaire

Arch Mal Coeur