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• W3105217650 abstract "Dr. Shokoohi and colleagues provide an excellent framework for the use of point-of-care ultrasonography (POCUS) that helps to ensure maximization of its benefits and minimization of potential harms.1 Their framework rightly emphasizes the importance of pre-test probability both in assessing the appropriateness of potential POCUS applications and in the integration of the results of a scan into clinical decisionmaking. In addition to the impact that pre-test probability has on post-test probability—highlighted in Table 1 of the paper and formalized in Bayes’ theorem—clinicians should also maintain an awareness that for certain pre-test probabilities scanning produces inaccurate results more often than accurate results.2 To calculate the pre-test probability that must be exceeded for true positives to exceed false positives the clinician can use an inequality: To calculate the pre-test probability that must not be surpassed to ensure a negative test more likely represents a true negative than false negative the clinician can use the inequality: pre-test probability < specificity/[(1-sensitivity) + specificity] The authors also highlight the importance of considering likelihood ratios when using POCUS to ascertain the presence or absence of disease and suggest that a positive likelihood ratio > 10 and negative likelihood ratio <.1 generally characterize a useful test. At the bedside, many POCUS users may also find Dr. McGee's highly cited paper on the subject useful.3 He demonstrates that likelihood ratios of .1, .2, and .5 approximately correspond to decreases in probability of disease by 45%, 30%, and 15% respectively when pre-test probabilities range from 10% to 90%. Paralleling this—and serving as a mnemonic—the likelihood ratios of 2, 5, and 10 correspond to increases in probability of disease by 15%, 30%, and 45% respectively. Finally, only with a perfectly reliable reference standard and absolute homogeneity in response to a diagnostic test in those with and without disease will sensitivity and specificity stand as unvarying measures of accuracy.4 To suggest, as Dr. Shokoohi et al do, that in “theory” severity of disease should not affect sensitivity and specificity seems somewhat imprecise and misleading even though they go on to point out that spectrum of disease does, in practice, affect these measures of diagnostic accuracy. Nonetheless, this remains a minor quibble that does little to detract from this important and timely paper that provides guiding principles for the optimal use of POCUS. None. The views expressed are solely those of the authors and do not reflect the official policy or position of the US Army, US Navy, US Air Force, the Department of Defense, or the US Government. None." @default.
• W3105217650 created "2020-11-23" @default.
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• W3105217650 date "2020-11-06" @default.
• W3105217650 modified "2023-09-23" @default.
• W3105217650 title "Users’ guide to point‐of‐care ultrasonography" @default.
• W3105217650 cites W2017460912 @default.
• W3105217650 cites W2080912638 @default.
• W3105217650 doi "https://doi.org/10.1002/emp2.12314" @default.
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