Diamond G A, Forrester J S
N Engl J Med. 1979 Jun 14;300(24):1350-8. doi: 10.1056/NEJM197906143002402.
The diagnosis of coronary-artery disease has become increasingly complex. Many different results, obtained from tests with substantial imperfections, must be integrated into a diagnostic conclusion about the probability of disease in a given patient. To approach this problem in a practical manner, we reviewed the literature to estimate the pretest likelihood of disease (defined by age, sex and symptoms) and the sensitivity and specificity of four diagnostic tests: stress electrocardiography, cardiokymography, thallium scintigraphy and cardiac fluoroscopy. With this information, test results can be analyzed by use of Bayes' theorem of conditional probability. This approach has several advantages. It pools the diagnostic experience of many physicians ans integrates fundamental pretest clinical descriptors with many varying test results to summarize reproducibly and meaningfully the probability of angiographic coronary-artery disease. This approach also aids, but does not replace, the physician's judgment and may assit in decisions on cost effectiveness of tests.
冠状动脉疾病的诊断变得越来越复杂。从存在大量缺陷的检测中获得的许多不同结果，必须整合到关于特定患者患病概率的诊断结论中。为了以实际的方式解决这个问题，我们回顾了文献，以估计疾病的预检可能性（由年龄、性别和症状定义）以及四种诊断测试的敏感性和特异性：运动心电图、心动记波图、铊闪烁扫描和心脏荧光检查。有了这些信息，就可以使用条件概率的贝叶斯定理来分析测试结果。这种方法有几个优点。它汇集了许多医生的诊断经验，并将基本的预检临床描述与许多不同的测试结果相结合，以可重复且有意义地总结血管造影冠状动脉疾病的概率。这种方法也有助于，但不能取代，医生的判断，并且可能有助于做出关于测试成本效益的决策。
