RT Journal
A1 Bates HR
T1 SEnsitivity, specificity, and predictive values in the 'sensitivity and specificity of clinical diagnostics'
JF JAMA
JO JAMA
YR 1989
FD July 21
VO 262
IS 3
SP 350
OP 351
DO 10.1001/jama.1989.03430030038020
UL http://dx.doi.org/10.1001/jama.1989.03430030038020
AB To the Editor.—
The article concerning postmortem evaluation of clinical diagnostics during five decades1 is a good effort to analyze disparate data that can be resistant to marshaling by ordinary statistical methods. However, I think that the true-negative category, within the constraints of this study, is largely a passive statistic that sheds little light on the diagnostic process. This occurs because the act of making a clinical diagnosis leads to a mutually exclusive binomial distribution of that diagnosis vs a statistical universe of other diagnoses, many of which are trivial. On the other hand, "agreed" (true positives), "underdiagnosed" (false negatives), and "overdiagnosed" (false positives) are intuitively satisfying categories that present a more realistic picture of actual practice.Another statistical method avoids the true-negative dilemma by using only those cells of the fourfold (2 × 2) tables that can be occupied by at least one positive diagnosis (clinical or autopsy).