Hlatky M, Botvinick E, Brundage B
Am J Cardiol. 1982 Jun;49(8):1927-31. doi: 10.1016/0002-9149(82)90211-9.
Probability analysis has provided insights into the use of diagnostic tests in coronary artery disease, and recent developments may permit clinical application of individual patients. To validate independently two available methods of probability calculation, their diagnostic accuracy was compared with that of cardiologists. Ninety-one cardiologists participated in the study; each evaluated the clinical summaries of eight randomly selected patients. For each patient, the cardiologist assessed the probability of coronary artery disease after reviewing the clinical history, physical examination and laboratory data, including complete results from a treadmill exercise test. The probability of coronary artery disease was also obtained for each patient, using the identical information, from two methods employing Bayes' rule: (1) from a published table of data based on the patient's age, sex, symptoms and degree of S-T segment change during exercise; and (2) from a computer program using the age, sex, risk factors, resting electrocardiogram and multiple exercise measurements. Diagnostic accuracy was assessed on a scale from 0 to 100 with the coronary angiogram as the diagnostic standard. The average diagnostic accuracy on this scale was: 80.2 for the cardiologists' estimates, 78.0 for the estimates based on tables (difference from cardiologists' estimates p less than 0.05) and 83.1 for the estimates based on computer calculations (p less than 0.01). Thus probability analysis incorporating sufficient detail can achieve a diagnostic accuracy comparable with that of cardiologists. Studies of the efficacy of probability analysis in patient care are warranted.
概率分析为冠状动脉疾病诊断测试的应用提供了见解，并且最近的进展可能允许在个体患者中进行临床应用。为了独立验证两种现有的概率计算方法，将它们的诊断准确性与心脏病专家的诊断准确性进行了比较。91位心脏病专家参与了该研究；每人评估了8名随机选择患者的临床摘要。对于每位患者，心脏病专家在查看临床病史、体格检查和实验室数据（包括跑步机运动试验的完整结果）后评估了冠状动脉疾病的概率。还使用贝叶斯法则的两种方法，利用相同信息为每位患者获得冠状动脉疾病的概率：（1）根据患者的年龄、性别、症状和运动期间S-T段变化程度，从已发表的数据表中获取；（2）通过使用年龄、性别、风险因素、静息心电图和多次运动测量值的计算机程序获取。以冠状动脉造影作为诊断标准，以0至100的量表评估诊断准确性。在此量表上的平均诊断准确性为：心脏病专家估计值为80.2，基于表格的估计值为78.0（与心脏病专家估计值的差异p小于0.05），基于计算机计算的估计值为83.1（p小于0.01）。因此，纳入足够详细信息的概率分析可以达到与心脏病专家相当的诊断准确性。有必要对概率分析在患者护理中的疗效进行研究。
