Streiner David L
Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, 3560 Bathurst Street, Toronto, Ontario, Canada M6A 2E1.
J Pers Assess. 2003 Dec;81(3):209-19. doi: 10.1207/S15327752JPA8103_03.
Tests can be used either diagnostically (i.e., to confirm or rule out the presence of a condition in people suspected of having it) or as a screening instrument (determining who in a large group of people has the condition and often when those people are unaware of it or unwilling to admit to it). Tests that may be useful and accurate for diagnosis may actually do more harm than good when used as a screening instrument. The reason is that the proportion of false negatives may be high when the prevalence is high, and the proportion of false positives tends to be high when the prevalence of the condition is low (the usual situation with screening tests). My first aim of this article is to discuss the effects of the base rate, or prevalence, of a disorder on the accuracy of test results. My second aim is to review some of the many diagnostic efficiency statistics that can be derived from a 2 x 2 table, including the overall correct classification rate, kappa, phi, the odds ratio, positive and negative predictive power and some variants of them, and likelihood ratios. In the last part of this article, I review the recent Standards for Reporting of Diagnostic Accuracy guidelines (Bossuyt et al., 2003) for reporting the results of diagnostic tests and extend them to cover the types of tests used by psychologists.
检测可用于诊断（即，确认或排除疑似患有某种疾病的人的患病情况）或作为筛查工具（确定一大群人中哪些人患有该疾病，而且通常是在这些人未意识到或不愿承认自己患病时）。对诊断可能有用且准确的检测，用作筛查工具时实际上可能弊大于利。原因在于，患病率高时假阴性比例可能很高，而疾病患病率低时（筛查检测的常见情况）假阳性比例往往很高。本文的首要目的是讨论疾病的基础率或患病率对检测结果准确性的影响。我的第二个目的是回顾一些可从2×2表格得出的众多诊断效率统计量，包括总体正确分类率、kappa系数、phi系数、优势比、阳性和阴性预测值及其一些变体，以及似然比。在本文的最后部分，我回顾了最近的《诊断准确性报告标准》指南（博叙伊特等人，2003年），用于报告诊断检测的结果，并将其扩展以涵盖心理学家使用的检测类型。
