Basic principles of Diagnostic

test (1)
Ideal diagnostic tests right answers:
Ideal diagnostic tests right answers:
(+)

results in everyone with the disease and

( - ) results in everyone else
Clinical

prediction rules, algorithm

Usual clinical practice:
The

test be studied in the same way it would be used

in the clinical setting

Observational
Predictor

study, and consists of:

variable (test result)

Outcome variable (presence / absence of the disease

Basic principles of Diagnostic

test (2)
Sensitivity,

specificity
Prevalence, prior probability, predictive values
Likelihood ratios
Dichotomous scale, cutoff points (continuous
scale)
Positive (true and false), negative (true and
false)
ROC (receiver operator characteristic) curve

Diagnostic test
general structure : 2 X 2 tables
Target disorder
Positive
(disease)

Target disorder
Negative
(normal)

Predictor
Test
positive

True positive
TP
a

False
positive
FP
b

Predictor
Test
negative

False negative
FN
c

True
negative
TN
d

Sensitivity, specificity, predictive values, likelihood ratios, ROC

EBM Issues on diagnostic tests:

Is

this evidence about the accuracy of a

diagnostic test valid?
Does this valid evidence demonstrate
an important ability to accurately
distinguish patients who do and dont
have a specific disorder?
Can I apply this valid and important
diagnostic test to a specific patient?

Validity

Importance (1)
Does this (valid) evidence
demonstrate an important ability
of this test to accurately
distinguish patients who do and
dont have a specific disorder?

Sensitivity
Specificity
Likelihood ratios

 Specifity

If a test is 100 % specific, it reacts

positively only when the client
actually has the condition being
tested. The important factors that
can effect a false positive reaction
such as drugs.

 Sencitivity

The sencitivity of a test is the degree

to which a test detects disease
without yielding a false negative
diagnosis.

 Normal

Reference Values
Normal reference values or reference
values is not as normal values
because its laboratory must
determine what is normal for a test
performed in specific laboratory

Metric Measurments Used in Laboratory Reports

Weight
Kilogram (kg)
Gram (g)
Milligram (mg) = 1/1000 of a g
Microgram (g) = 1/1000 of a mg
Nanogram (ng) = 1/1000 of a g
Picogram (pg) = 1/1000 of a ng
Femtogram (fg) = 1/1000 of a pg
Volume
Liter (L)
= 1000 ml (or 1000 cc)
qt
Deciliter (dL) = 100 ml or 1/10 of a L
Milliliter (mL) = 1 ml or 1/1000 0f a L

2,2 lb
453 g = 1 lb

1.05

Usual Test Done Automatically by Cell

Counters

Hct Hematocrit
Hb Hemoglobin
WBC
White blood cells/ leukocyte
RBC Red blood cells/ eritrocyte
MCV
Mean corpuscular volume
MCH
Mean corpuscular hemoglobin
MCHC
Mean corpuscular hemoglobin concentration
RDW
Red blood cell distribution width
PLT (Plateled counts may also be performed with some
counters

Importance (2)

Importance (3)
Odds = ratio of two probabilities
Odds = p/1-p
Probability = odds/1+odds
Likelihood ratio (+) :
Prop (+) result in people with the disease
Prop (+) result in people w/out the disease
Pretest Odds X LR = Posttest Odds

Pretest
probability

Likelihood
ratio

Posttest
probability

The usefulness of 5 levels of

diagnostic test result

Accuracy of the test

The accuracy of the test

depends on how well the
test separates the group
being tested into those
with and without the
disease in question
Accuracy is measured by
the area under the ROC
curve. An area of 1
represents a perfect test;
an area of 0.5 represents
a worthless test (AUC)

0.90-1.00 = excellent
(A)
0.80-0.90 = good (B)
0.70-0.80 = fair (C)
0.60-0.70 = poor (D)
0.50-0.60 = fail (F)

Applicability

Diagnostic tests
Is

not about finding absolute truth,

but about limiting uncertainty
establishes both the necessity and the
logical base for introducing probabilities,
pragmatic test-treatment thresholds ..
Start thinking about
what youre going to do with the results of
the
diagnostic test, and
whether doing the test will help your
patients

Conclusion
EBM is nothing more than a
framework of systematic use of
current valid study results
relevant to our patients

End result
Self directed, life-long
learning attitude
for high quality patient
care

The Principle of diagnostic

determine :
Anamnestic
Physical Diagnostic

1.
2.

3.

Auscultation, Palpation
Percution, Inspection etc

Diagnostic Tests :
LABORATORY

X-RAY
E.K.G
ENDOSCOPY

Clinical Laboratory Test

1.
2.
3.
4.

HEMATOLOGY
CLINICAL CHEMISTRY
IMUNO SEROLOGY
MIKROBIOLOGY/PARASITOLOG
Y

The useful of Laboratory

test
1.
2.
3.
4.
5.

Determine of disease
To Help established diagnostic
To evaluation of disease prolong.
Monitoring of therapy.
To predict of prognostic

Hemathology tests
1.

2.
3.

FULL BLOOD COUNT

RBC/ERYTHROCYTE,
WBC/LEUKOCYTE, HB, HCT, MCH,
MCHC, MCV, PLT, DIFF WBC COUNT
(PMN, LYMFOCYTE, MONOCYTE), ESR.
BLOOD FILM
HEMOSTATIC TESTS :
PT.APTT,TT,FIBRINOGEN

4. RETICULOCYTE COUNT
5. BONE MARROW ASPIRATION

Clinical Chemystri Tests :

1.

Liver Function Tests : GGT, ALT/SGPT, AST/SGOT,

6.
7.

Uric Acid
ELEKTROLYTE (K,Na,CL) MINERAL (Ca.Mg,P) DLL

BILIRUBIN TOTAL, BIL. DIRECT/INDIRECT, ALKALI

PHOSPHATASE, TOTAL PROTEIN, ALBUMIN, GLOBULIN
2. Diabetic Mellitus Tests: GLUKOSE (PUASA,PP2
JAM,OGTT), HbA1c
3. Renal Function Test: UREUM,KREATININ CLEARANCE
UREUM,CREATININ
4. Cardiac Enzyme Tests: CK, CKMB, MYOGLOBIN,
LDH).
5. Blood Lipid tests: TG, TOTAL CHOLESTEROL,
HDL/LDL CHOLESTEROL, LIPOPROTEIN, APO A,B,C .

IMUNOSEROLOGI TESTS
1.

Virus Infection Tests:

VIRAL HEPATITIS A (Ig M,igG HAV)

VIRAL HEPATITIS B (HbsAg .Anti HBS, HBeAg Anti
HBe,HBV DNA)
VIRAL HEPATITIS C(Anti HCV)
Tes HIV, DHF, TORCH, DLL.

2.

Bacterical Infection Tests (WIDAL,

3.

Paracyte Infection Tests (ICT

VDRL,TPHA, MYCODOT, ETC)

PLASMODIUM VIVAX, FALCIPARUM ETC)

4. Hormonal Tests (TSH, FT 4, ETC)
5. Tumor Markers Tests : (CEA, AFP, PSA,
CA 125, ETC)

MIKROBIOLOGY/PARASITOLOGY
TESTS :
1.
2.
3.
4.

5.

IDENTIFICATION DAN ISOLATION

TEST (CULTUR, BIOKIMIA)
MICROSCOPYC TESTS (GRAM,
ZIEHL NILSEN, NEISSER ETC)
P.C.R TEST
BLOOD FILM THIN/THICK
(MORFOLOGY PLASMODIUM,
AMOEBA, HELMINTHES, YEAST ETC
IMUNOLOGY/SEROLOGY

Routine Urinalysis and Other

Urine Tests :

pH
Specific Gravity
Protein
Sugar
Ketones
Sediment (crystals, casts, WBCs, RBCs )
Leukocyte Esterase
Urinary Porphyrins
Bilirubin
Urobilinogen
Nitrites