Pretest expectations strongly influence interpretation of abnormal laboratory results and further management

BMC Family Practice

Research Article

Trudy van der Weijden¹  Paul HH Houben¹  Ron AG Winkens²  Richard PTM Grol³  Bjorn Winkens⁴ 

[1] Maastricht University, School of Public Health and Primary Care (CAPHRI), Department of General Practice, PO Box 616, 6200, Maastricht, MD, The Netherlands;Maastricht University, School of Public Health and Primary Care (CAPHRI), Department of General Practice, PO Box 616, 6200, Maastricht, MD, The Netherlands;Maastricht University Medical Centre, Integrated Care Unit, PO Box 5800, 6202, Maastricht, AZ, The Netherlands;Maastricht University, School of Public Health and Primary Care (CAPHRI), Department of General Practice, PO Box 616, 6200, Maastricht, MD, The Netherlands;Radboud University Nijmegen, Scientific Institute for Quality of Healthcare, PO Box 9101, 6500, Nijmegen, HB, The Netherlands;Maastricht University, School of Public Health and Primary Care (CAPHRI), Department of Methodology and Statistics, PO Box 616, 6200, Maastricht, MD, The Netherlands;

关键词: Primary Care Physician;    Generalize Estimate Equation;    Probability Estimate;    Abnormal Result;    Pretest Probability;   

DOI  :  10.1186/1471-2296-11-13

 received in 2009-03-31, accepted in 2010-02-16,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundAbnormal results of diagnostic laboratory tests can be difficult to interpret when disease probability is very low. Although most physicians generally do not use Bayesian calculations to interpret abnormal results, their estimates of pretest disease probability and reasons for ordering diagnostic tests may - in a more implicit manner - influence test interpretation and further management. A better understanding of this influence may help to improve test interpretation and management. Therefore, the objective of this study was to examine the influence of physicians' pretest disease probability estimates, and their reasons for ordering diagnostic tests, on test result interpretation, posttest probability estimates and further management.MethodsProspective study among 87 primary care physicians in the Netherlands who each ordered laboratory tests for 25 patients. They recorded their reasons for ordering the tests (to exclude or confirm disease or to reassure patients) and their pretest disease probability estimates. Upon receiving the results they recorded how they interpreted the tests, their posttest probability estimates and further management. Logistic regression was used to analyse whether the pretest probability and the reasons for ordering tests influenced the interpretation, the posttest probability estimates and the decisions on further management.ResultsThe physicians ordered tests for diagnostic purposes for 1253 patients; 742 patients had an abnormal result (64%). Physicians' pretest probability estimates and their reasons for ordering diagnostic tests influenced test interpretation, posttest probability estimates and further management. Abnormal results of tests ordered for reasons of reassurance were significantly more likely to be interpreted as normal (65.8%) compared to tests ordered to confirm a diagnosis or exclude a disease (27.7% and 50.9%, respectively). The odds for abnormal results to be interpreted as normal were much lower when the physician estimated a high pretest disease probability, compared to a low pretest probability estimate (OR = 0.18, 95% CI = 0.07-0.52, p < 0.001).ConclusionsInterpretation and management of abnormal test results were strongly influenced by physicians' estimation of pretest disease probability and by the reason for ordering the test. By relating abnormal laboratory results to their pretest expectations, physicians may seek a balance between over- and under-reacting to laboratory test results.

【 授权许可】

CC BY   
© Houben et al; licensee BioMed Central Ltd. 2010