The sensitivity and specificity of clinical diagnostics during five decades: toward an understanding of necessary fallibility

Article Abstract:

The sensitivity and specificity of more than 50,000 autopsies was assessed to evaluate the discrepancy rate between premortem (before death) diagnosis and postmortem (after death) diagnosis occurring between 1930 and 1977. Sensitivity is a measure of the ability of the autopsy to detect the cause; specificity on the other hand measures the ability to distinguish between competing probable causes of death. The conclusions of the study apply only to patients who die and are autopsied; they do not extend to patient who recover. Although underdiagnosis is a more common diagnostic error than overdiagnosis, either may adversely effect the patient. The results demonstrated that when a diagnosis is made, there is a high probability that it will be verified at autopsy. On the other hand, the absence of a specific clinical diagnosis only provides a modest reduction in the probability that it will be found at autopsy. With the exception of leukemia, these generalizations appear to be independent of disease prevalence. The high discrepancy rate is usually associated with the increased numbers of aged people, in whom signs and symptoms are often masked, and with the occasionally unpredictable effects of some modern therapies. A number of observers have pointed out, however, that physician factors, not patient factors, are responsible for most missed diagnoses. Historically, researchers conclude that a "lack of mental alertness or awareness" on the part of the physician seems to be the most common cause of diagnostic error. There is evidence that diagnostic technology has not had an impact on the accuracy of premortem clinical diagnoses, and some studies suggest that an excessive reliance on diagnostic testing may adversely affect diagnostic accuracy. The researchers believe that the discovery of systematic faults in the medical diagnostic process can be corrected. While learning can improve diagnostic performance, society as a whole must also accept a realistic view of the fallibility of physicians in making clinical diagnoses.

Evaluation, Clinical medicine, Surveys, Autopsy

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Outbreaks of pseudo-infection with Cyclospora and Cryptosporidium - Florida and New York City, 1995

Article Abstract:

Two false outbreaks of gastrointestinal infections illustrate the need for proper training of laboratory technicians and independent confirmation of test results by more sophisticated laboratory methods. In an alleged outbreak of Cyclospora in Florida, a state laboratory found evidence of Cyclospora cysts in 56 people at a children's shelter. However, analysis at the CDC revealed that many were false positives. A similar situation occurred in New York City during an alleged Cryptosporidium outbreak.

Infection, Cryptosporidiosis, Gastrointestinal system

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Molecular diagnostics of hepatitis C virus infection: A systematic review

Article Abstract:

A systematic review is used to analyze the molecular diagnostics tests available for hepatitis C virus (HCV), their clinical applications and their impact on the natural history of HCV. The results have shown that a sensitive nucleic acid test can be used to confirm all cases of acute or chronic HCV infection.

United States, Prevention, Risk factors, Hepatitis C, Disease/Disorder overview

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