Pretest probability assessment derived from attribute matching

Jeffrey A. Kline, Charles L. Johnson, Charles V. Pollack, Deborah B. Diercks, Judd E. Hollander, Craig Newgard, J. Lee Garvey

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background: Pretest probability (PTP) assessment plays a central role in diagnosis. This report compares a novel attribute-matching method to generate a PTP for acute coronary syndrome (ACS). We compare the new method with a validated logistic regression equation (LRE). Methods: Eight clinical variables (attributes) were chosen by classification and regression tree analysis of a prospectively collected reference database of 14,796 emergency department (ED) patients evaluated for possible ACS. For attribute matching, a computer program identifies patients within the database who have the exact profile defined by clinician input of the eight attributes. The novel method was compared with the LRE for ability to produce PTP estimation st-3rd quartile 1-10%] compared with the LRE, which produced 96 unique PTP estimates [median 24%, 1st-3rd quartile 10-30%]. The areas under the receiver operating characteristic curves were 0.74 (95% CI 0.65 to 0.82) for the attribute matching curve and 0.68 (95% CI 0.62 to 0.77) for LRE. The attribute matching system categorized 1,670 (24%, 95% CI = 23-25%) patients as having a PTP <2.0%; 28 developed ACS (1.7% 95% CI = 1.1-2.4%). The LRE categorized 244 (4%, 95% CI = 3-4%) with PTP <2.0%; four developed ACS (1.6%, 95% CI = 0.4-4.1%). Conclusion: Attribute matching estimated a very low PTP for ACS in a significantly larger proportion of ED patients compared with a validated LRE.

Original languageEnglish (US)
JournalBMC Medical Informatics and Decision Making
Volume5
DOIs
StatePublished - Aug 11 2005

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Acute Coronary Syndrome
Logistic Models
Hospital Emergency Service
Databases
ROC Curve
Software
Regression Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kline, J. A., Johnson, C. L., Pollack, C. V., Diercks, D. B., Hollander, J. E., Newgard, C., & Garvey, J. L. (2005). Pretest probability assessment derived from attribute matching. BMC Medical Informatics and Decision Making, 5. https://doi.org/10.1186/1472-6947-5-26

Pretest probability assessment derived from attribute matching. / Kline, Jeffrey A.; Johnson, Charles L.; Pollack, Charles V.; Diercks, Deborah B.; Hollander, Judd E.; Newgard, Craig; Garvey, J. Lee.

In: BMC Medical Informatics and Decision Making, Vol. 5, 11.08.2005.

Research output: Contribution to journalArticle

Kline, Jeffrey A. ; Johnson, Charles L. ; Pollack, Charles V. ; Diercks, Deborah B. ; Hollander, Judd E. ; Newgard, Craig ; Garvey, J. Lee. / Pretest probability assessment derived from attribute matching. In: BMC Medical Informatics and Decision Making. 2005 ; Vol. 5.
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abstract = "Background: Pretest probability (PTP) assessment plays a central role in diagnosis. This report compares a novel attribute-matching method to generate a PTP for acute coronary syndrome (ACS). We compare the new method with a validated logistic regression equation (LRE). Methods: Eight clinical variables (attributes) were chosen by classification and regression tree analysis of a prospectively collected reference database of 14,796 emergency department (ED) patients evaluated for possible ACS. For attribute matching, a computer program identifies patients within the database who have the exact profile defined by clinician input of the eight attributes. The novel method was compared with the LRE for ability to produce PTP estimation st-3rd quartile 1-10{\%}] compared with the LRE, which produced 96 unique PTP estimates [median 24{\%}, 1st-3rd quartile 10-30{\%}]. The areas under the receiver operating characteristic curves were 0.74 (95{\%} CI 0.65 to 0.82) for the attribute matching curve and 0.68 (95{\%} CI 0.62 to 0.77) for LRE. The attribute matching system categorized 1,670 (24{\%}, 95{\%} CI = 23-25{\%}) patients as having a PTP <2.0{\%}; 28 developed ACS (1.7{\%} 95{\%} CI = 1.1-2.4{\%}). The LRE categorized 244 (4{\%}, 95{\%} CI = 3-4{\%}) with PTP <2.0{\%}; four developed ACS (1.6{\%}, 95{\%} CI = 0.4-4.1{\%}). Conclusion: Attribute matching estimated a very low PTP for ACS in a significantly larger proportion of ED patients compared with a validated LRE.",
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