The Utility of Routine Screening of Patients With Uveitis for Systemic Lupus Erythematosus or Tuberculosis: A Bayesian Analysis

James (Jim) Rosenbaum, Richard Wernick

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

The indications for many laboratory tests in patients with uveitis are controversial. Bayes' theorem allows a mathematical approach to the assessment of the utility of a laboratory test based on the sensitivity of the test, the specificity of the test, and the pretest likelihood that the disease the test is intended to identify is present. We have utilized Bayes' theorem to assess the utility of routine antinuclear antibody and purified protein derivative testing in patients with uveitis. Based on published data about the sensitivity and specificity of each of these tests, as well as the prevalence of systemic lupus erythematosus and tuberculosis among patients with uveitis, we calculated that a patient with uveitis and a positive antinuclear antibody test result has less than a 1% chance of having systemic lupus erythematosus and that a patient with uveitis and a positive purified protein derivative test result has a 1% likelihood of having tuberculosis. These low probabilities mean that neither test is useful in the routine evaluation of patients with uveitis, and indiscriminate use may lead to improper diagnosis, increased costs, and, occasionally, inappropriate therapy.

Original languageEnglish (US)
Pages (from-to)1291-1293
Number of pages3
JournalArchives of Ophthalmology
Volume108
Issue number9
DOIs
StatePublished - 1990

Fingerprint

Bayes Theorem
Uveitis
Systemic Lupus Erythematosus
Tuberculosis
Antinuclear Antibodies
Sensitivity and Specificity
Proteins
Costs and Cost Analysis

ASJC Scopus subject areas

  • Ophthalmology

Cite this

@article{731e22dadc84407ebd6d0df01d23a756,
title = "The Utility of Routine Screening of Patients With Uveitis for Systemic Lupus Erythematosus or Tuberculosis: A Bayesian Analysis",
abstract = "The indications for many laboratory tests in patients with uveitis are controversial. Bayes' theorem allows a mathematical approach to the assessment of the utility of a laboratory test based on the sensitivity of the test, the specificity of the test, and the pretest likelihood that the disease the test is intended to identify is present. We have utilized Bayes' theorem to assess the utility of routine antinuclear antibody and purified protein derivative testing in patients with uveitis. Based on published data about the sensitivity and specificity of each of these tests, as well as the prevalence of systemic lupus erythematosus and tuberculosis among patients with uveitis, we calculated that a patient with uveitis and a positive antinuclear antibody test result has less than a 1{\%} chance of having systemic lupus erythematosus and that a patient with uveitis and a positive purified protein derivative test result has a 1{\%} likelihood of having tuberculosis. These low probabilities mean that neither test is useful in the routine evaluation of patients with uveitis, and indiscriminate use may lead to improper diagnosis, increased costs, and, occasionally, inappropriate therapy.",
author = "Rosenbaum, {James (Jim)} and Richard Wernick",
year = "1990",
doi = "10.1001/archopht.1990.01070110107034",
language = "English (US)",
volume = "108",
pages = "1291--1293",
journal = "JAMA Ophthalmology",
issn = "2168-6165",
publisher = "American Medical Association",
number = "9",

}

TY - JOUR

T1 - The Utility of Routine Screening of Patients With Uveitis for Systemic Lupus Erythematosus or Tuberculosis

T2 - A Bayesian Analysis

AU - Rosenbaum, James (Jim)

AU - Wernick, Richard

PY - 1990

Y1 - 1990

N2 - The indications for many laboratory tests in patients with uveitis are controversial. Bayes' theorem allows a mathematical approach to the assessment of the utility of a laboratory test based on the sensitivity of the test, the specificity of the test, and the pretest likelihood that the disease the test is intended to identify is present. We have utilized Bayes' theorem to assess the utility of routine antinuclear antibody and purified protein derivative testing in patients with uveitis. Based on published data about the sensitivity and specificity of each of these tests, as well as the prevalence of systemic lupus erythematosus and tuberculosis among patients with uveitis, we calculated that a patient with uveitis and a positive antinuclear antibody test result has less than a 1% chance of having systemic lupus erythematosus and that a patient with uveitis and a positive purified protein derivative test result has a 1% likelihood of having tuberculosis. These low probabilities mean that neither test is useful in the routine evaluation of patients with uveitis, and indiscriminate use may lead to improper diagnosis, increased costs, and, occasionally, inappropriate therapy.

AB - The indications for many laboratory tests in patients with uveitis are controversial. Bayes' theorem allows a mathematical approach to the assessment of the utility of a laboratory test based on the sensitivity of the test, the specificity of the test, and the pretest likelihood that the disease the test is intended to identify is present. We have utilized Bayes' theorem to assess the utility of routine antinuclear antibody and purified protein derivative testing in patients with uveitis. Based on published data about the sensitivity and specificity of each of these tests, as well as the prevalence of systemic lupus erythematosus and tuberculosis among patients with uveitis, we calculated that a patient with uveitis and a positive antinuclear antibody test result has less than a 1% chance of having systemic lupus erythematosus and that a patient with uveitis and a positive purified protein derivative test result has a 1% likelihood of having tuberculosis. These low probabilities mean that neither test is useful in the routine evaluation of patients with uveitis, and indiscriminate use may lead to improper diagnosis, increased costs, and, occasionally, inappropriate therapy.

UR - http://www.scopus.com/inward/record.url?scp=0025039509&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025039509&partnerID=8YFLogxK

U2 - 10.1001/archopht.1990.01070110107034

DO - 10.1001/archopht.1990.01070110107034

M3 - Article

C2 - 2205185

AN - SCOPUS:0025039509

VL - 108

SP - 1291

EP - 1293

JO - JAMA Ophthalmology

JF - JAMA Ophthalmology

SN - 2168-6165

IS - 9

ER -