ࡱ> _a^` bjbjss .R8888888L4%4%4%8l%<%L3@&@&:z&z&z&U'U'U'22222224hk6R28 (U'U' ( (288z&z&2... (V8z&8z&2. (2..88.z&4& _`_4%b*.1203.6>+66..68/TU'i'.w' 'U'U'U'22t,>U'U'U'3 ( ( ( (LLLD"LLL"LLL888888 Date: Dev. Date:Duration: Topic:ID:NCTL0010Title: Positive and negative predictive value of diagnostic testsAuthor(s): Elaine BentleyDeveloper(s): Learning objective: To be able to define and calculate the terms positive and negative predictive value for diagnostic testsKeywords: Positive predictive value, negative predictive value, diagnostic test(s)Summary: This RLO explains how diagnostic test results are a combination of true and false positive, or true and false negative. Notes: Use people icons rather than dots on matrices Allow students as much interactivity as possible eg dragging and dropping values/labels into tables etc Include images where possible eg for section on asthma might include images of peak flow measurement Keep text in animations to a minimum, or have narration as audio only with an option for printed text Narration needs to be rewritten in places for audio presentation Presentation: Introduction Diagnosis is an essential step in medical care. Usually this involves diagnostic tests of some description. A health check is also a group of diagnostic tests. Decisions about medical treatment are made on the basis of test results. An ideal, or truly accurate, test will always give a positive result with disease, and a negative result without disease. This is not the case for all tests. In practice this means that not all positive test results will represent disease. This is described by the Positive Predictive Value (PPV). Equally, not all negative results will represent no disease. This is described by the Negative Predictive Value (NPV). Positive predictive value is defined as the proportion of those with a positive test result who actually have disease. Negative predictive value is defined as the proportion of those with a negative test result who do not have disease. Tests In a group of 100 people, 60 have disease, 40 do not have disease. Our ideal test applied to all these people will give 60 positive results in those who have disease and 40 negative results in those without disease. In practice tests are not perfect, so not all diseased patients will be picked up by the test. In this case the test gives a positive result in 48 out of the 60 who have disease, therefore 48 are true positive. However, if the test is negative for all cases without disease, then all the positive tests show disease. False results For most tests a negative result is not always obtained when there is no disease. Some patients will have a positive result, even if no disease is present. These are therefore, false positives, as the test is incorrect. Equally for most tests a positive result is not always obtained when there is disease. Some cases have a negative result, even if disease is present. These are therefore, false negatives, as the test is incorrect. Positive test results are a sum of the true positive and false positive results. Negative test results are a sum of the true negative and false negative results. Prediction table Data is usually presented as a table. Disease present or absent must be determined by some means and this is usually called the gold or reference standard. Positive Predictive Value answers the question about how likely a positive test is to represent disease. Putting the numbers into our table gives a PPV of 48/60 = 80% The NPV is 28/40 = 70% This data is obtained from studies where the number of people with disease is known. In practice we dont know who has disease or who hasnt (otherwise we would not need to do a test!). Images etc: Selection of different tests eg taking blood, x-ray, ECG PPV and NPV come in as mentioned See PowerPoint file for ideas P = TP + FP moves in N = TN + FN moves in Drag appropriate numbers into boxes Interaction: Choose value from a movable scale. Correct answer = 85% Correct answer = 5. Interaction: Drag a box over the number of patients. Correct answer = 2 Again drag a box over the correct number. Blank box with titles and values to drag into the appropriate slot. Then drag values for calculating PPV and NPV. Correct answer = 6. Using PPV and NPV What does a Positive Predictive Value of 85% mean? For every 100 positive tests in patients from a similar population how many would be true positives? A positive test result usually means that a patient will have treatment or a further test. In an asthma clinic a positive test is followed by corticosteroid treatment. If there are 20 positive tests and a PPV of 75%, how many patients would be given corticosteroids unnecessarily? The NPV for the same test in the same clinic is 90%. For every 20 patients who test negative, how many will be false negative? Assessment: In an asthma clinic a positive test is followed by treatment. If there are 20 positive tests and a PPV of 75%, how many patients would be given treatment unnecessarily? Fill in the box with the titles and values of true positive (44), false positive (6), true negative (27) and false negative (3) How many patients would be given treatment unnecessarily? Links (1): To RLO on sensitivity and specificityLinks (2): To RLO on PPV and prevalenceGlossary: Positive predictive value: the proportion of those with a positive test result who actually have disease. Negative predictive value: the proportion of those with a negative test result who do not have disease. False positive: a positive test result in a patient without disease. False negative result: a negative test result in a patient with disease. Reference standard: the presence or absence of disease determined by approved methods. Prevalence: the amount of a particular disease in a population at a given point in time. 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