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1 - Introduction: understanding diagnosis and diagnostic testing

Published online by Cambridge University Press:  04 August 2010

Thomas B. Newman  and
Michael A. Kohn
Thomas B. Newman
Affiliation:
University of California, San Francisco
Michael A. Kohn
Affiliation:
University of California, San Francisco
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Summary

Two areas of evidence-based medicine: diagnosis and treatment

The term “evidence-based medicine” (EBM) was coined by Gordon Guyatt and colleagues of McMaster University around 1992 (Evidence-Based Medicine Working Group 1992). Oversimplifying greatly, EBM is about using the best available evidence to help in two related areas:

  • Diagnosis: How to evaluate a test and then use it to estimate the probability that a patient has a given disease.

  • Treatment: How to determine whether a treatment is beneficial in patients with a given disease, and if so, whether the benefits outweigh the costs and risks.

The two areas of evidence-based diagnosis and treatment are closely related. Although a diagnosis can be useful for prognosis, epidemiologic tracking, and scientific study, it may not be worth the costs and risks of testing to diagnose a disease that has no effective treatment. Even if an effective treatment exists, there are probabilities of disease so low that it is not worth testing for the disease. These probabilities depend not only on the cost and accuracy of the test, but also on the effectiveness of the treatment. As suggested by the title, this book focuses more intensively on the diagnosis area of EBM.

Type
Chapter
Information
Evidence-Based Diagnosis , pp. 1 - 9
Publisher: Cambridge University Press
Print publication year: 2009

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References

Evidence-Based Medicine Working Group (1992). “Evidence-based medicine. A new approach to teaching the practice of medicine.” JAMA 268(17): 2420–5.CrossRef
Kohn, M. A., Kerr, K., et al. (2003). “Beta-human chorionic gonadotropin levels and the likelihood of ectopic pregnancy in emergency department patients with abdominal pain or vaginal bleeding.” Acad Emerg Med 10(2): 119–26.CrossRefGoogle ScholarPubMed
Lee, T. H., and Goldman, L. (2000). “Evaluation of the patient with acute chest pain.” N Engl J Med 342(16): 1187–95.CrossRefGoogle ScholarPubMed
AAP, (1999). “Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection.” Pediatrics 103(4 Pt 1): 843–52.Google Scholar
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Hodson, E. M., Wheeler, D. M., et al. (2007). “Interventions for primary vesicoureteric reflux.” Cochrane Database Syst Rev 3: CD001532.CrossRefGoogle ScholarPubMed
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Newman, T. B. (2006). “Much pain, little gain from voiding cystourethrograms after urinary tract infection.” Pediatrics 118(5): 2251.CrossRefGoogle ScholarPubMed
Evidence-Based Medicine Working Group (1992). “Evidence-based medicine. A new approach to teaching the practice of medicine.” JAMA 268(17): 2420–5.CrossRef
Kohn, M. A., Kerr, K., et al. (2003). “Beta-human chorionic gonadotropin levels and the likelihood of ectopic pregnancy in emergency department patients with abdominal pain or vaginal bleeding.” Acad Emerg Med 10(2): 119–26.CrossRefGoogle ScholarPubMed
Lee, T. H., and Goldman, L. (2000). “Evaluation of the patient with acute chest pain.” N Engl J Med 342(16): 1187–95.CrossRefGoogle ScholarPubMed

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