Foy R, Warner P
Department of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh EH3 9ER, UK.
Qual Saf Health Care. 2003 Jun;12(3):205-9. doi: 10.1136/qhc.12.3.205.
Clinical guidelines often make recommendations on the use of diagnostic tests. Compared with sensitivity and specificity, the use of pre- and post-test probabilities allows a more explicit and rational selection and interpretation of diagnostic tests. Ideally, clinical guidelines relating to diagnosis should routinely incorporate this information to enhance individualised decision making. We report our experience of incorporating pre- and post-test probabilities into a guideline on the investigation of women with postmenopausal bleeding developed by the Scottish Intercollegiate Guidelines Network. Issues relating to their application are highlighted, including the limitations of available evidence on diagnostic tests and prevalence of disease, acceptability to guideline users, and the uncertain impact on actual clinical decision making. Despite these potential difficulties, the incorporation of data on pre- and post-test probabilities into the development and presentation of guideline recommendations may offer an important opportunity to make clinical decision making more transparent for both clinicians and patients.
临床指南常常就诊断测试的使用给出建议。与敏感性和特异性相比，使用检验前概率和检验后概率能使诊断测试的选择和解读更加明确且合理。理想情况下，有关诊断的临床指南应常规纳入此类信息，以加强个体化决策。我们报告了将检验前概率和检验后概率纳入苏格兰校际指南网络制定的绝经后出血女性调查指南的经验。文中强调了与它们应用相关的问题，包括诊断测试现有证据的局限性、疾病患病率、指南使用者的可接受性，以及对实际临床决策的不确定影响。尽管存在这些潜在困难，但将检验前概率和检验后概率数据纳入指南建议的制定和展示过程，可能为让临床决策对临床医生和患者双方而言都更加透明提供重要契机。
