Intro to Diagnosis Flashcards
Why use diagnostics?
Make REASONED decisions about patient care based on clinical information and estimated outcomes
Used as a screening tool, to assist with diagnosis (urinalysis) and for patient management (measure blood glucose in diabetic)
Considerations
is it invasive? Is it expensive? Some diagnostics carry a risk of morbidity or mortality
False positives can lead to incorrect diagnosis or further unnecessary testing
Criteria used for screening tests:
Characteristic of population
characteristic of disease
characteristic of test
characteristics of population
sufficiently high prevalence of disease
likely to be compliant with subsequent tests and treatments
characteristics of disease
significant morbidity and mortality
effective and acceptable treatment readily available
pre-symptomatic period detectable
improved outcome from early treatment
characteristics of test!
good sensitivity and specificity, low cost and risk, confirmatory test available and practical
performance of diagnostic tests rely on what two things?
patient preparation (fasting, electrolyte restrictions, posture, physical activity prior, compliance)
specimen collection (proper labeling, test timing, medium of collection, proper site and technique [drawing blood above an IV], handling and storage)
test characteristics:
accuracy
precision
reference interval
interfering factors
sensitivity and specificity
sigma metrics (eh)
accuracy (bias)
test deemed inaccurate when result differs from true value, even if test is precise, AKA systematic error or bias
precision
if same specimen is analyzed many times, some variation (random error) is expected
this variability is expressed as a coefficient of variation percentage (CV)
ex: lab reports: serum creatinine with a CV of 5% and accepts results within 2 SD, so if expected result is 1, anywhere from 0.9-1.10 is accepted
sigma metrics
0-6
3 or less is bad
reference intervals in practice
(used on tests with quantitative results vs qualitative results)
represent test results found in 95% of a small pop presumed healthy, meaning 5% of healthy pop will have abnormal test result
Interfering factors (external and internal)
external: certain drugs/meds, contrast media, alcohol/cigs
internal: endogenous antibodies, diet, abnormal physiological states
sensitivity and specificity (both independent of prevalence of disease)
sensitivity: ability of test to detect disease expressed as % of patients with disease in whom the test was + (true positive vs false positive)
-commonly used for screening
-TP/TP + FN (TP/total diseased)
-vertical math
specificity: ability of a test to detect absence of disease expressed as % of patients without disease in whom test is - (true negative vs false negative)
-commonly used for definitive diagnoses
-TN/TN + FP (TN/total non-diseased)
-vertical math
positive predictive value
depends on prevalence of test in population
it is the probability of having the disease if test is positive
TP/TP + FP = PPV
negative predictive value
directly related to prevalence of disease
probably that a person is actually disease free if test is negative
TN/TN + FN = NPV
PPV vs NPV (horizontal math)
PPV: likelihood of having the disease when the test is positive
- directly related to prevalence
NPV: likelihood of not having the disease when the rest is negative
-inversely related to prevalence
prevalence equation
total positive/total number of patients x 100
methods of blood collection
venous, arterial, skin puncture
venous puncture
primary source of blood collection
most common is antecubital fossa of arm (mainly radial, sometimes ulna if Allen test permits)
basilic, cephalic and median cubital veins, femoral vein
venipuncture possible complications
bleeding, hematoma, infection, dizziness and fainting
arterial puncture
used to measure o2, co2 and pH, more difficult, more discomfort, brachial and radial most common used, may use femoral
skin puncture
Used in pediatric patients: finger tip (capillary), heel (in infants), ear lobes (very vascular)
preventing interfering factors
hemolysis: don’t shake tubes
Don’t collect from an arm with an IV running
avoid side with lymph node dissection
tourniquet shouldn’t be applied over a min.