Signs and Evidence

Making clinical sense of scientific data

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AF on ECG
 Atrial fibrillation
 Positive likelihood ratio
10.22 ( J. Mant, D.A. )
(average) 10.22
Negative likelihood ratio
0.09 ( J. Mant, D.A. )
(average) 0.09
Anemia
 Temporal Arteritis
 Positive likelihood ratio
1.22 ( Ryan D et al. )
(average) 1.22
Negative likelihood ratio
0.92 ( Ryan D et al. )
(average) 0.92
Ankle-brachial index < 0,90
 Peripheral arterial disease
 Positive likelihood ratio
7.93 ( Carmo GA et al. )
(average) 7.93
Negative likelihood ratio
0.31 ( Carmo GA et al. )
(average) 0.31
Anti-CCP antibody
 Rheumatoid arthritis
 Positive likelihood ratio
12.46 ( Nishimura K et al. )
7.78 ( Payet J et al. )
(average) 10.12
Negative likelihood ratio
0.36 ( Nishimura K et al. )
0.33 ( Payet J et al. )
(average) 0.35
BNP > 100 pg/ml
 Heart failure
 Positive likelihood ratio
3.75 ( Maisel AS et al. )
(average) 3.75
Negative likelihood ratio
0.13 ( Maisel AS et al. )
(average) 0.13
Chest X-ray
 Pneumonia in adults
 Positive likelihood ratio
3.00 ( Laursen CB et al. )
6.71 ( Ticinesi A et al. )
2.50 ( Bourcier JE et al. )
(average) 4.07
Negative likelihood ratio
0.40 ( Laursen CB et al. )
0.57 ( Ticinesi A et al. )
0.53 ( Bourcier JE et al. )
(average) 0.5
 Pneumonia in children
 Positive likelihood ratio
6.40 ( Ianniello S et al. )
(average) 6.4
Negative likelihood ratio
0.40 ( Ianniello S et al. )
(average) 0.4
 Heart failure
 Positive likelihood ratio
14.75 ( Kennedy S et al. )
4.00 ( Taylor C et al. )
(average) 9.38
Negative likelihood ratio
0.43 ( Kennedy S et al. )
0.39 ( Taylor C et al. )
(average) 0.41
CK-MB subforms ratio > 1,6 after 6 hours
 Acute coronary syndrome
 Positive likelihood ratio
8.27 ( Zimmerman J et al. )
(average) 8.27
Negative likelihood ratio
0.10 ( Zimmerman J et al. )
(average) 0.1
Color doppler ultrasonography for arteritis
 Temporal Arteritis
 Positive likelihood ratio
9.60 ( Diamantopoulos AP et al. )
(average) 9.6
Negative likelihood ratio
0.04 ( Diamantopoulos AP et al. )
(average) 0.04
CRP > 100 mg/l
 Pneumonia in adults
 Positive likelihood ratio
2.68 ( Le Bel J. Diagnostic )
(average) 2.68
Negative likelihood ratio
0.53 ( Le Bel J. Diagnostic )
(average) 0.53
 Temporal Arteritis
 Positive likelihood ratio
4.10 ( Battista NA et al. )
(average) 4.1
Negative likelihood ratio
0.66 ( Battista NA et al. )
(average) 0.66
CRP > 250 mg/l
 Pneumonia in children
 Positive likelihood ratio
23 ( Koster MJ et al. )
(average) 23
Negative likelihood ratio
0.78 ( Koster MJ et al. )
(average) 0.78
CT angiography
 Peripheral arterial disease
 Positive likelihood ratio
24.50 ( Li XM et al. )
(average) 24.5
Negative likelihood ratio
0.02 ( Li XM et al. )
(average) 0.02
CT for cholecystitis
 Cholecystitis
 Positive likelihood ratio
6.00 ( Klugsberger B et al. )
(average) 6
Negative likelihood ratio
0.12 ( Klugsberger B et al. )
(average) 0.12
CT for disc herniation
 Disc herniation
 Positive likelihood ratio
2.85 ( Rijn RM et al. )
(average) 2.85
Negative likelihood ratio
0.32 ( Rijn RM et al. )
(average) 0.32
EEG
 Epilepsy
 Positive likelihood ratio
3.14 ( Chowdhury AH et al. )
3.30 ( Dantas GF et al. )
(average) 3.22
Negative likelihood ratio
0.43 ( Chowdhury AH et al. )
0.74 ( Dantas GF et al. )
(average) 0.59
Electrodiagnostic testing (EDX)
 Carpal tunnel syndrome
 Positive likelihood ratio
3.64 ( Fowler JR et al. )
2.59 ( Atroshi I et al. )
(average) 3.12
Negative likelihood ratio
0.26 ( Fowler JR et al. )
0.41 ( Atroshi I et al. )
(average) 0.34
Erosions on X-ray
 Rheumatoid arthritis
 Positive likelihood ratio
11 ( Rindfleisch JA et al. )
(average) 11
Negative likelihood ratio
0.8 ( Rindfleisch JA et al. )
(average) 0.8
ESR > 100 mm/hr
 Temporal Arteritis
 Positive likelihood ratio
2.47 ( Ryan D et al. )
1.14 ( Battista NA et al. )
(average) 1.81
Negative likelihood ratio
0.77 ( Ryan D et al. )
0.96 ( Battista NA et al. )
(average) 0.87
Hematuria
 Urinary tract infection in women
 Positive likelihood ratio
1.59 ( Little P et al. )
(average) 1.59
Negative likelihood ratio
0.50 ( Little P et al. )
(average) 0.5
Hip X-ray
 Hip arthrosis
 Positive likelihood ratio
5.33 ( Xu L et al. )
(average) 5.33
Negative likelihood ratio
0.41 ( Xu L et al. )
(average) 0.41
Leukocytes in urine
 Urinary tract infection in women
 Positive likelihood ratio
2.37 ( Laosu-angkoon S et al. )
2.52 ( Daghistani HA et al. )
1.83 ( Little P et al. )
(average) 2.24
Negative likelihood ratio
0.08 ( Laosu-angkoon S et al. )
0.44 ( Daghistani HA et al. )
0.27 ( Little P et al. )
(average) 0.26
Leukocytosis (> 10000 / ml)
 Cholecystitis
 Positive likelihood ratio
1.47 ( Trowbridge RL et al. )
(average) 1.47
Negative likelihood ratio
0.65 ( Trowbridge RL et al. )
(average) 0.65
 Appendicitis
 Positive likelihood ratio
2.23 ( Al-gaithy Zuhoor K et )
1.60 ( Saaiq M et al. )
1.89 ( Dahmardehei M et al. )
2.91 ( Kamran H et al. )
(average) 2.16
Negative likelihood ratio
0.35 ( Al-gaithy Zuhoor K et )
0.21 ( Saaiq M et al. )
0.26 ( Dahmardehei M et al. )
0.32 ( Kamran H et al. )
(average) 0.29
 Diverticulitis
 Positive likelihood ratio
11.28 ( O'Connor ES et al. )
1.60 ( Stefánsson R et )
(average) 6.44
Negative likelihood ratio
0.24 ( O'Connor ES et al. )
0.33 ( Stefánsson R et )
(average) 0.29
Lung ultrasound
 Pneumonia in adults
 Positive likelihood ratio
15.33 ( Ticinesi A et al. )
16.40 ( Nazerian P et al. )
2.21 ( Bourcier JE et al. )
6.57 ( Xia Y et al. )
(average) 10.13
Negative likelihood ratio
0.09 ( Ticinesi A et al. )
0.19 ( Nazerian P et al. )
0.09 ( Bourcier JE et al. )
0.08 ( Xia Y et al. )
(average) 0.11
 Pneumonia in children
 Positive likelihood ratio
13.50 ( Ianniello S et al. )
(average) 13.5
Negative likelihood ratio
0.20 ( Ianniello S et al. )
(average) 0.2
MRI for anterior cruciate ligament tear
 Anterior cruciate ligament tear (acute)
 Positive likelihood ratio
17.20 ( Richards PJ et al. )
8.70 ( Li K et al. )
16 ( Oei EH et al. )
6.64 ( Crawford R et al. )
(average) 12.14
Negative likelihood ratio
0.15 ( Richards PJ et al. )
0.14 ( Li K et al. )
0.06 ( Oei EH et al. )
0.08 ( Crawford R et al. )
(average) 0.11
 Anterior cruciate ligament tear (chronic)
 Positive likelihood ratio
17.20 ( Richards PJ et al. )
8.70 ( Li K et al. )
16 ( Oei EH et al. )
6.64 ( Crawford R et al. )
(average) 12.14
Negative likelihood ratio
0.15 ( Richards PJ et al. )
0.14 ( Li K et al. )
0.06 ( Oei EH et al. )
0.08 ( Crawford R et al. )
(average) 0.11
MRI for cholecystitis
 Cholecystitis
 Positive likelihood ratio
4.78 ( Kiewiet JJS et al. )
(average) 4.78
Negative likelihood ratio
0.17 ( Kiewiet JJS et al. )
(average) 0.17
MRI for disc herniation
 Disc herniation
 Positive likelihood ratio
2.73 ( Chawalparit O et al. )
(average) 2.73
Negative likelihood ratio
0.26 ( Chawalparit O et al. )
(average) 0.26
MRI for meniscal tear
 Meniscal tear (acute)
 Positive likelihood ratio
7.85 ( Crawford R et al. )
6.22 ( Jah AAE et al. )
(average) 7.04
Negative likelihood ratio
0.11 ( Crawford R et al. )
0.27 ( Jah AAE et al. )
(average) 0.19
MRI for posterior cruciate ligament tear
 Posterior cruciate ligament tear
 Positive likelihood ratio
91 ( Oei EH et al. )
(average) 91
Negative likelihood ratio
0.09 ( Oei EH et al. )
(average) 0.09
MRI for rotator cuff tear
 Rotator cuff injury
 Positive likelihood ratio
7.58 ( Zlatkin MB et al. )
4.25 ( Patten RM et al. )
1.77 ( Wnorowski DC et al. )
(average) 4.53
Negative likelihood ratio
0.10 ( Zlatkin MB et al. )
0.19 ( Patten RM et al. )
0.29 ( Wnorowski DC et al. )
(average) 0.19
Nitrite in urine
 Urinary tract infection in women
 Positive likelihood ratio
2.52 ( Daghistani HA et al. )
6.24 ( Little P et al. )
(average) 4.38
Negative likelihood ratio
0.55 ( Daghistani HA et al. )
0.75 ( Little P et al. )
(average) 0.65
Normal ECG
 Acute coronary syndrome
 Positive likelihood ratio
0.14 ( Mant J et al. )
(average) 0.14
Negative likelihood ratio
1.58 ( Mant J et al. )
(average) 1.58
Phadiatop
 Allergic rhinitis
 Positive likelihood ratio
7.6 ( Vidal C et al. )
3.13 ( Tschopp JM et al. )
(average) 5.37
Negative likelihood ratio
0.3 ( Vidal C et al. )
0.36 ( Tschopp JM et al. )
(average) 0.33
PSA > 4,0
 Prostate cancer
 Positive likelihood ratio
2.33 ( Adhyam M et al. )
2.86 ( Ankerst DP et al. )
1.18 ( Yunusa B et al. )
10.29 ( Mistry K et al. )
(average) 4.17
Negative likelihood ratio
0.87 ( Adhyam M et al. )
0.86 ( Ankerst DP et al. )
0.38 ( Yunusa B et al. )
0.30 ( Mistry K et al. )
(average) 0.6
Q-waves
 Acute coronary syndrome
 Positive likelihood ratio
5.01 ( Mant J et al. )
(average) 5.01
Negative likelihood ratio
0.45 ( Mant J et al. )
(average) 0.45
RF
 Rheumatoid arthritis
 Positive likelihood ratio
4.86 ( Nishimura K et al. )
8.4 ( Rindfleisch JA et al. )
9.5 ( Miller A et al. )
(average) 7.59
Negative likelihood ratio
0.38 ( Nishimura K et al. )
0.4 ( Rindfleisch JA et al. )
0.5 ( Miller A et al. )
(average) 0.43
Specific IgE > 0,35 kU/l
 B-lactam allergy
 Positive likelihood ratio
21.50 ( Siles RI et al. )
(average) 21.5
Negative likelihood ratio
0.58 ( Siles RI et al. )
(average) 0.58
ST-depression
 Acute coronary syndrome
 Positive likelihood ratio
5.0 ( Fanaroff AC et al. )
3.13 ( Mant J et al. )
(average) 4.07
Negative likelihood ratio
0.8 ( Fanaroff AC et al. )
0.60 ( Mant J et al. )
(average) 0.7
ST-elevation
 Acute coronary syndrome
 Positive likelihood ratio
13.1 ( Mant J et al. )
(average) 13.1
Negative likelihood ratio
0.47 ( Mant J et al. )
(average) 0.47
Temporal artery biopsy
 Temporal Arteritis
 Positive likelihood ratio
13.40 ( Diamantopoulos AP et al. )
(average) 13.4
Negative likelihood ratio
0.35 ( Diamantopoulos AP et al. )
(average) 0.35
Thrombocytosis
 Temporal Arteritis
 Positive likelihood ratio
5.98 ( Ryan D et al. )
20.00 ( Costello F et al. )
(average) 12.99
Negative likelihood ratio
0.56 ( Ryan D et al. )
0.41 ( Costello F et al. )
(average) 0.49
Transcranial ultrasound
 Parkinson disease
 Positive likelihood ratio
5.00 ( Gaenslen A et al. )
1.03 ( Bouwmans AE et al. )
6.38 ( Li DH et al. )
(average) 4.14
Negative likelihood ratio
0.12 ( Gaenslen A et al. )
0.98 ( Bouwmans AE et al. )
0.20 ( Li DH et al. )
(average) 0.43
Troponin I > 1,5 ng/mL after 6 hours
 Acute coronary syndrome
 Positive likelihood ratio
15.33 ( Zimmerman J et al. )
(average) 15.33
Negative likelihood ratio
0.09 ( Zimmerman J et al. )
(average) 0.09
TSH > 5,0 mU/l
 Hypothyroidism
 Positive likelihood ratio
27.00 ( Abu-Helalah M et al. )
(average) 27
Negative likelihood ratio
0.20 ( Abu-Helalah M et al. )
(average) 0.2
Ultrasound for appendicitis
 Appendicitis
 Positive likelihood ratio
4.94 ( Al-Ajerami Y et al. )
16.60 ( Al-Khayal KA et al. )
45.50 ( Toorenvliet BR et al. )
30.33 ( Neufeld D et al. )
14.17 ( Doria AS et al. )
(average) 22.31
Negative likelihood ratio
0.19 ( Al-Ajerami Y et al. )
0.18 ( Al-Khayal KA et al. )
0.09 ( Toorenvliet BR et al. )
0.09 ( Neufeld D et al. )
0.16 ( Doria AS et al. )
(average) 0.14
Ultrasound for cholecystitis
 Cholecystitis
 Positive likelihood ratio
4.32 ( Kiewiet JJS et al. )
13.80 ( Klugsberger B et al. )
2.84 ( Kumar K et al. )
4.40 ( Shea JA et al. )
(average) 6.34
Negative likelihood ratio
0.22 ( Kiewiet JJS et al. )
0.33 ( Klugsberger B et al. )
0.57 ( Kumar K et al. )
0.15 ( Shea JA et al. )
(average) 0.32
Ultrasound for cholelithiasis
 Cholelithiasis
 Positive likelihood ratio
19.40 ( Shea JA et al. )
7.42 ( Kola S et al. )
(average) 13.41
Negative likelihood ratio
0.03 ( Shea JA et al. )
0.12 ( Kola S et al. )
(average) 0.08
Ultrasound for De Quervain tenosynovitis
 De Quervain tenosynovitis
 Positive likelihood ratio
13.71 ( Lee KH et al. )
(average) 13.71
Negative likelihood ratio
0.04 ( Lee KH et al. )
(average) 0.04
Ultrasound for diverticulitis
 Diverticulitis
 Positive likelihood ratio
91.00 ( Chou YH et al. )
4.3 ( Ripolles T et al. )
3.9 ( Parente F et al. )
11.6 ( Hollerweger A et al. )
9.2 ( Sarma D et al. )
(average) 24
Negative likelihood ratio
0.09 ( Chou YH et al. )
0.19 ( Ripolles T et al. )
0.24 ( Parente F et al. )
0.17 ( Hollerweger A et al. )
0.09 ( Sarma D et al. )
(average) 0.16