Abstract
Screening and diagnostic tests are applied for the classification of people into diseased and non-diseased populations. Although diagnostic accuracy measures are used to evaluate the correctness of classification in clinical research and practice, there has been limited research on their uncertainty. The objective for this work was to develop a tool for calculating the uncertainty of diagnostic accuracy measures, as diagnostic accuracy is fundamental to clinical decision-making. For this reason, the freely available interactive program Diagnostic Uncertainty has been developed in the Wolfram Language. The program provides six modules with nine submodules for calculating and plotting the standard combined, measurement and sampling uncertainty and the resultant confidence intervals of various diagnostic accuracy measures of screening or diagnostic tests, which measure a normally distributed measurand, applied at a single point in time to samples of non-diseased and diseased populations. This is done for differing sample sizes, mean and standard deviation of the measurand, diagnostic threshold and standard measurement uncertainty of the test. The application of the program is demonstrated with an illustrative example of glucose measurements in samples of diabetic and non-diabetic populations, that shows the calculation of the uncertainty of diagnostic accuracy measures. The presented interactive program is user-friendly and can be used as a flexible educational and research tool in medical decision-making, to calculate and explore the uncertainty of diagnostic accuracy measures.
Highlights
The application of the program is demonstrated with an illustrative example of glucose measurements in samples of diabetic and non-diabetic populations, that shows the calculation of the uncertainty of diagnostic accuracy measures
The values of the standard combined, measurement and sampling uncertainties of diagnostic accuracy measures of a screening or diagnostic test are plotted versus the diagnostic threshold of the test (Figure 3)
The values of the relative standard combined, measurement and sampling uncertainties of diagnostic accuracy measures of a screening or diagnostic test are plotted versus the diagnostic threshold of the test (Figure 4)
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Diagnosis in medicine is the determination of the nature of a disease condition [1]. It is assumed that there is a dichotomy between the populations with and without a disease condition. The probability distributions of the measurand of a quantitative diagnostic test in each of the diseased and non-diseased populations are overlapping. There is a persistent need of estimating the uncertainty of diagnostic accuracy measures, especially regarding screening and diagnostic tests of life-threatening diseases. There has been extensive research on either diagnostic accuracy or uncertainty, extremely limited research has been done on both subjects [8,9,10,11]. Diagnostic accuracy is fundamental to clinical decision-making [12], Populations.
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