<i>Annals</i> Clinical Decision Making: Using a Diagnostic Test
Authors: Katrina A. Armstrong, Joshua P. Metlay
Journal: Annals of Internal Medicine (2020)

Special Articles5 May 2020Annals Clinical Decision Making: Using a Diagnostic TestKatrina A. Armstrong, MD, MS and Joshua P. Metlay, MD, PhDKatrina A. Armstrong, MD, MSMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (K.A.A., J.P.M.) and Joshua P. Metlay, MD, PhDMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (K.A.A., J.P.M.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1940 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Diagnostic tests are important tools in clinical decision making (1, 2). However, they are often misunderstood and misused (3). This article uses 2 clinical examples to review the principles of interpreting diagnostic test results and outline an approach to the appropriate selection and application of tests in internal medicine (Table 1).Table 1. Approach to Use of Diagnostic TestsCase 1A 50-year-old man presented to urgent care in Boston in late May with 5 days of cough, anorexia, and fever after returning from a trip to India. Results of the patient's rapid ...References1. Griner PF, Mayewski RJ, Mushlin AI, et al. Selection and interpretation of diagnostic tests and procedures: principles and applications. Ann Intern Med. 1981;94:557-92. [PMID: 6452080] MedlineGoogle Scholar2. Jaeschke R, Guyatt GH, Sackett DL. Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA. 1994;271:703-7. [PMID: 8309035] CrossrefMedlineGoogle Scholar3. Zhi M, Ding EL, Theisen-Toupal J, et al. The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PLoS One. 2013;8:e78962. [PMID: 24260139] doi:10.1371/journal.pone.0078962 CrossrefMedlineGoogle Scholar4. Centers for Disease Control and Prevention. Rapid diagnostic testing for influenza: information for clinical laboratory directors. Accessed at www.cdc.gov/flu/professionals/diagnosis/rapidlab.htm on 6 August 2019. Google Scholar5. Restrepo D, Armstrong KA, Metlay JP. Annals clinical decision making: avoiding cognitive errors in clinical decision making. Ann Intern Med. 21 April 2020. [Epub ahead of print]. doi:10.7326/M19-3692 LinkGoogle Scholar6. Metlay JP, Armstrong KA. Annals clinical decision making: incorporating perspective into clinical decisions. Ann Intern Med. 21 April 2020. [Epub ahead of print]. doi:10.7326/M19-3469 LinkGoogle Scholar7. Liaño F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996;50:811-8. [PMID: 8872955] CrossrefMedlineGoogle Scholar8. American College of Radiology. ACR Appropriateness Criteria. Accessed at www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria on 6 August 2019. Google Scholar9. Pauker SG, Kassirer JP. The threshold approach to clinical decision making. N Engl J Med. 1980;302:1109-17. [PMID: 7366635] CrossrefMedlineGoogle Scholar10. Rhee C, Dantes R, Epstein L, et al; CDC Prevention Epicenter Program. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA. 2017;318:1241-9. [PMID: 28903154] doi:10.1001/jama.2017.13836 CrossrefMedlineGoogle Scholar11. Andriolo BN, Andriolo RB, Salomão R, et al. Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock. Cochrane Database Syst Rev. 2017;1:CD010959. [PMID: 28099689] doi:10.1002/14651858.CD010959.pub2 CrossrefMedlineGoogle Scholar12. Lamy B, Dargère S, Arendrup MC, et al. How to optimize the use of blood cultures for the diagnosis of bloodstream infections? A state-of-the art. Front Microbiol. 2016;7:697. [PMID: 27242721] doi:10.3389/fmicb.2016.00697 CrossrefMedlineGoogle Scholar13. Srivastava R, Bartlett WA, Kennedy IM, et al. Reflex and reflective testing: efficiency and effectiveness of adding on laboratory tests. Ann Clin Biochem. 2010;47:223-7. [PMID: 20392754] doi:10.1258/acb.2010.009282 CrossrefMedlineGoogle Scholar14. Craig WY, Ledue TB. The antinuclear antibody assay: developing criteria for reflexive anti-dsDNA antibody testing in a laboratory setting. Clin Chem Lab Med. 2011;49:1205-11. [PMID: 21612543] doi:10.1515/CCLM.2011.613 CrossrefMedlineGoogle Scholar15. Kavanaugh AF, Solomon DH; American College of Rheumatology Ad Hoc Committee on Immunologic Testing Guidelines. Guidelines for immunologic laboratory testing in the rheumatic diseases: anti-DNA antibody tests. Arthritis Rheum. 2002;47:546-55. [PMID: 12382306] CrossrefMedlineGoogle Scholar16. Armstrong KA, Metlay JP. Annals clinical decision making: communicating risk and engaging patients in shared decision making. Ann Intern Med. 21 April 2020. [Epub ahead of print]. doi:10.7326/M19-3495 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (K.A.A., J.P.M.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1940.Corresponding Author: Katrina A. Armstrong, MD, Massachusetts General Hospital, Gray-Bigelow 7, 55 Fruit Street, Boston, MA 02114; e-mail, [email protected]harvard.edu.Current Author Addresses: Dr. Armstrong: Massachusetts General Hospital, Gray-Bigelow 7, 55 Fruit Street, Boston, MA 02114.Dr. Metlay: Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114.Author Contributions: Conception and design: K.A. Armstrong, J.P. Metlay.Analysis and interpretation of the data: J.P. Metlay.Drafting of the article: K.A. Armstrong.Critical revision of the article for important intellectual content: K.A. Armstrong, J.P. Metlay.Final approval of the article: K.A. Armstrong, J.P. Metlay.Administrative, technical, or logistic support: K.A. Armstrong, J.P. Metlay.This article was published at Annals.org on 21 April 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoClinical Decision Making: Nurturing Our Core Skills Darren B. Taichman , Sankey V. Williams , and Christine Laine Metrics Cited byAnatomy of diagnosis in a clinical encounter: how clinicians discuss uncertainty with patientsIs there a place for a molecular diagnostic test for pelvic inflammatory disease in primary care? 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Williams, MD, Deputy Editor, and Christine Laine, MD, MPH, Editor in Chief 5 May 2020Volume 172, Issue 9Page: 604-609KeywordsBiopsyDecision makingLikelihood ratioMedical servicesNegative predictive valuePatientsPositive predictive valueSepsisSpecificityUltrasound imaging ePublished: 21 April 2020 Issue Published: 5 May 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...