Narrative
The Bottom Line: Clinician judgment performs better when looking at the constellation of findings to determine diagnosis.
Caveats
- Authors identify Centor scoring method as being validated with an ROC of 0.79 but this is for an adult population that is not where Strep throat incidence peaks (children 24-36% vs 5-24% adults).
- There are 9 clinical prediction rules for strep throath. Not all references provide LRs or ROCs and most have limitations for their use).
Author
Khaled Hassan, MD and Shahriar Zehtabchi, MD
Published/Updated
February 25, 2013
What are Likelihood Ratios?
LR, pretest probability and posttest (or posterior) probability are daunting terms that describe simple concepts that we all intuitively understand.
Let's start with pretest probability: that's just a fancy term for my initial impression, before we perform whatever test it is that we're going to use.
For example, a patient with prior stents comes in sweating and clutching his chest in agony, I have a pretty high suspicion that he's having an MI – let's say, 60%. That is my pretest probability.
He immediately gets an ECG (known here as the "test") showing an obvious STEMI.
Now, I know there are some STEMI mimics, so I'm not quite 100%, but based on my experience I'm 99.5% sure that he's having an MI right now. This is my posttest probability - the new impression I have that the patient has the disease after we did our test.
And likelihood ration? That's just the name for the statistical tool that converted the pretest probability to the posttest probability - it's just a mathematical description of the strength of that test.
Using an online calculator, that means the LR+ that got me from 60% to 99.5% is 145, which is about as high an LR you can get (and the actual LR for an emergency physician who thinks an ECG shows an obvious STEMI).
(Thank you to Seth Trueger, MD for this explanation!)
