How to use diagnostic test articles in the intensive care unit: Diagnosing weanability using f/Vt

被引:38
作者
Jaeschke, RZ
Meade, MO
Guyatt, GH
Keenan, SP
Cook, DJ
机构
[1] MCMASTER UNIV, FAC HLTH SCI,ST JOSEPHS HOSP,DEPT MED, DIV CRIT CARE, HAMILTON, ON L8N 4A6, CANADA
[2] MCMASTER UNIV, FAC HLTH SCI, DEPT CLIN EPIDEMIOL & BIOSTAT, HAMILTON, ON, CANADA
[3] UNIV TORONTO, DEPT MED, DIV CRIT CARE, TORONTO, ON, CANADA
[4] UNIV WESTERN ONTARIO, FAC HLTH SCI,LONDON HLTH SCI CTR,DEPT MED, DIV CRIT CARE, LONDON, ENGLAND
关键词
diagnosis; diagnostic tests; pretest probability; sensitivity; specificity; likelihood ratios;
D O I
10.1097/00003246-199709000-00018
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Medical diagnosis involves generating a set of hypotheses and obtaining information that modifies these hypotheses, Sources of this information include the history, physical examination, and laboratory investigations, all of which function as diagnostic tests, Studies of diagnostic tests are useful when a) the population under study is representative of those to whom we would like to apply the results; b) when an independent, blind comparison is made of the test results with a reference standard; and c) when the reference standard is performed on all patients, rather than restricted to those patients with particular test results, Clinicians can use the data from such high quality studies in the form of sensitivity and specificity, as well as likelihood ratios, which indicate the direction and magnitude of the change in probability of a target condition from pretest to posttest. Study results will be more easily applicable to practice when the performance and interpretation of the test is similar in study and clinical settings, We conduct diagnostic tests primarily to improve the process of patient care and patient outcome, and test ordering behavior ideally reflects these goals.
引用
收藏
页码:1514 / 1521
页数:8
相关论文
共 24 条
[1]   ASSESSMENT OF DIAGNOSTIC-TESTS WHEN DISEASE VERIFICATION IS SUBJECT TO SELECTION BIAS [J].
BEGG, CB ;
GREENES, RA .
BIOMETRICS, 1983, 39 (01) :207-215
[2]   COMPARISON OF 3 METHODS OF GRADUAL WITHDRAWAL FROM VENTILATORY SUPPORT DURING WEANING FROM MECHANICAL VENTILATION [J].
BROCHARD, L ;
RAUSS, A ;
BENITO, S ;
CONTI, G ;
MANCEBO, J ;
REKIK, N ;
GASPARETTO, A ;
LEMAIRE, F .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1994, 150 (04) :896-903
[3]   OCCLUSION PRESSURE AND ITS RATIO TO MAXIMUM INSPIRATORY PRESSURE ARE USEFUL PREDICTORS FOR SUCCESSFUL EXTUBATION FOLLOWING T-PIECE WEANING TRIAL [J].
CAPDEVILA, XJ ;
PERRIGAULT, PF ;
PEREY, PJ ;
ROUSTAN, JPA ;
DATHIS, F .
CHEST, 1995, 108 (02) :482-489
[5]   Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously [J].
Ely, EW ;
Baker, AM ;
Dunagan, DP ;
Burke, HL ;
Smith, AC ;
Kelly, PT ;
Johnson, MM ;
Browder, RW ;
Bowton, DL ;
Haponik, EF .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 335 (25) :1864-1869
[6]   ETIOLOGY OF EXTUBATION FAILURE AND THE PREDICTIVE VALUE OF THE RAPID SHALLOW BREATHING INDEX [J].
EPSTEIN, SK .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1995, 152 (02) :545-549
[7]   A COMPARISON OF 4 METHODS OF WEANING PATIENTS FROM MECHANICAL VENTILATION [J].
ESTEBAN, A ;
FRUTOS, F ;
TOBIN, MJ ;
ALIA, I ;
SOLSONA, JF ;
VALVERDU, I ;
FERNANDEZ, R ;
DELACAL, MA ;
BENITO, S ;
TOMAS, R ;
CARRIEDO, D ;
MACIAS, S ;
BLANCO, J .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 332 (06) :345-350
[8]  
FAGAN TJ, 1975, NEW ENGL J MED, V293, P257
[9]   CONSTRUCTION OF RECEIVER OPERATING CHARACTERISTIC CURVES WHEN DISEASE VERIFICATION IS SUBJECT TO SELECTION BIAS [J].
GRAY, R ;
BEGG, CB ;
GREENES, RA .
MEDICAL DECISION MAKING, 1984, 4 (02) :151-164
[10]   FACTORS AFFECTING SENSITIVITY AND SPECIFICITY OF EXERCISE ELECTROCARDIOGRAPHY - MULTIVARIABLE ANALYSIS [J].
HLATKY, MA ;
PRYOR, DB ;
HARRELL, FE ;
CALIFF, RM ;
MARK, DB ;
ROSATI, RA .
AMERICAN JOURNAL OF MEDICINE, 1984, 77 (01) :64-71