LabDx
9/20/99
Testing Strategy
- Extra
costs are incurred here above the office visit
- Would
like to start treatment from a DDx for low risk groups
- This
keeps you competitive in the market
- Diagnostic
imaging
- Plain
films
- CT
- MRI
- Ultrasound
- Laboratory
- Physiological
Selection Criteria
- Sensitivity—test
will be positive when the pt has the disorder
- Would
like 100%
- Rarely
do we find a test that we can afford that is 100%
- Have
to weigh the amount of certainty you want to the cost (esp. in geriatric
population)
- Instead
may wait and monitor the pt for awhile and see if respond w/o the test
- False
negatives are when a test doesn't detect the problem
- Specificity—test
is negative when the pt doesn't have the problem
- Negative
tests and Negative labs to not make a normal pt
- Predictive
value—you want a solid, quality test done to get the most accurate answer
- Positive
- Negative
- Test
quality
- Will
alter sensitivity and specificity depending upon the population that you
are evaluating
- Determines
test quality factors in the prevalence of pathology
Sensitivity
- Fracture
of the C-spine
- High
sensitivity
- CT
- Bone
Scan--$700, 95-97% sensitive
- Cancer,
spondylolysis, occult fractures
Specificity
- Think
that you have a fracture
- Do a
bone scan
- Has a
high specificity for fracture, in the high 90%
EPT (early pregnancy test)
- 93-94%
accuracy
- Higher
sensitivity would be an ultrasound that cost several hundred dollars
- Specificity
is about 95%
Treatment
- Mirrors
Dx
- Functional,
spiritual, ??
- You
are not trying to get rid of pain, the pain will go away as the function
and etc improves
-