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, 28 (3), 521-5

Selecting Diagnostic Tests for Ruling Out or Ruling in Disease: The Use of the Kullback-Leibler Distance

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Selecting Diagnostic Tests for Ruling Out or Ruling in Disease: The Use of the Kullback-Leibler Distance

W C Lee. Int J Epidemiol.

Abstract

Background: To select a proper diagnostic test, it is recommended that the most specific test be used to confirm (rule in) a diagnosis, and the most sensitive test be used to establish that a disease is unlikely (rule out). These rule-in and rule-out concepts can also be characterized by the likelihood ratio (LR). However, previous papers discussed only the case of binary tests and assumed test results already known.

Methods: The author proposes using the 'Kullback-Leibler distance' as a new measure of rule-in/out potential. The Kullback-Leibler distance is an abstract concept arising from statistics and information theory. The author shows that it integrates in a proper way two sources of information--the distribution of test outcomes and the LR function. The index predicts the fate of an average subject before testing.

Results: Analysis of real and hypothetical data demonstrates its applications beyond binary tests. It works even when the conventional methods of dichotomization and ROC curve analysis fail.

Conclusions: The Kullback-Leibler distance nicely characterizes the before-test rule-in/out potentials. It offers a new perspective from which to evaluate a diagnostic test.

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