Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests

Diagnostic and screening tests may have risks such as misdiagnosis, as well as the potential benefits of correct diagnosis. Effective communication of this risk to both clinicians and patients can be problematic. The purpose of this study was to develop a metric called the “efficiency index” (EI), d...

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Autor principal:	Andrew J. Larner
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	dementia diagnosis efficiency index risk communication screening test Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/2e2a15d441de480ea3a7eda7d1ca8f6b
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spelling	oai:doaj.org-article:2e2a15d441de480ea3a7eda7d1ca8f6b2021-11-25T16:58:03ZCommunicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests10.3390/brainsci111114732076-3425https://doaj.org/article/2e2a15d441de480ea3a7eda7d1ca8f6b2021-11-01T00:00:00Zhttps://www.mdpi.com/2076-3425/11/11/1473https://doaj.org/toc/2076-3425Diagnostic and screening tests may have risks such as misdiagnosis, as well as the potential benefits of correct diagnosis. Effective communication of this risk to both clinicians and patients can be problematic. The purpose of this study was to develop a metric called the “efficiency index” (EI), defined as the ratio of test accuracy and inaccuracy, to evaluate screening tests for dementia. This measure was compared with a previously described “likelihood to be diagnosed or misdiagnosed” (LDM), also based on “numbers needed” metrics. Datasets from prospective pragmatic test accuracy studies examining four brief cognitive screening instruments (Mini-Mental State Examination; Montreal Cognitive Assessment; Mini-Addenbrooke’s Cognitive Examination (MACE); and Free-Cog) were analysed to calculate values for EI and LDM, and to examine their variation with test cut-off for MACE and dementia prevalence. EI values were also calculated using a modification of McGee’s heuristic for the simplification of likelihood ratios to estimate percentage change in diagnostic probability. The findings indicate that EI is easier to calculate than LDM and, unlike LDM, may be classified either qualitatively or quantitatively in a manner similar to likelihood ratios. EI shows the utility or inutility of diagnostic and screening tests, illustrating the inevitable trade-off between diagnosis and misdiagnosis. It may be a useful metric to communicate risk in a way that is easily intelligible for both clinicians and patients.Andrew J. LarnerMDPI AGarticledementiadiagnosisefficiency indexrisk communicationscreening testNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENBrain Sciences, Vol 11, Iss 1473, p 1473 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	dementia diagnosis efficiency index risk communication screening test Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	dementia diagnosis efficiency index risk communication screening test Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Andrew J. Larner Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests
description	Diagnostic and screening tests may have risks such as misdiagnosis, as well as the potential benefits of correct diagnosis. Effective communication of this risk to both clinicians and patients can be problematic. The purpose of this study was to develop a metric called the “efficiency index” (EI), defined as the ratio of test accuracy and inaccuracy, to evaluate screening tests for dementia. This measure was compared with a previously described “likelihood to be diagnosed or misdiagnosed” (LDM), also based on “numbers needed” metrics. Datasets from prospective pragmatic test accuracy studies examining four brief cognitive screening instruments (Mini-Mental State Examination; Montreal Cognitive Assessment; Mini-Addenbrooke’s Cognitive Examination (MACE); and Free-Cog) were analysed to calculate values for EI and LDM, and to examine their variation with test cut-off for MACE and dementia prevalence. EI values were also calculated using a modification of McGee’s heuristic for the simplification of likelihood ratios to estimate percentage change in diagnostic probability. The findings indicate that EI is easier to calculate than LDM and, unlike LDM, may be classified either qualitatively or quantitatively in a manner similar to likelihood ratios. EI shows the utility or inutility of diagnostic and screening tests, illustrating the inevitable trade-off between diagnosis and misdiagnosis. It may be a useful metric to communicate risk in a way that is easily intelligible for both clinicians and patients.
format	article
author	Andrew J. Larner
author_facet	Andrew J. Larner
author_sort	Andrew J. Larner
title	Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests
title_short	Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests
title_full	Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests
title_fullStr	Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests
title_full_unstemmed	Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests
title_sort	communicating risk: developing an “efficiency index” for dementia screening tests
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/2e2a15d441de480ea3a7eda7d1ca8f6b
work_keys_str_mv	AT andrewjlarner communicatingriskdevelopinganefficiencyindexfordementiascreeningtests
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Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests

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