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Evidence-based diagnosis and clinical decision making

PA Mileman*,1 and WB van den Hout2

1Department of Oral Radiology of the Academic Centre for Dentistry in Amsterdam (ACTA), Amsterdam, The Netherlands; 2Department of Medical Decision Making, University of Leiden Medical Center (LUMC), Leiden, The Netherlands


Figure 1
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  		Figure 1 The road to effective decision making for the patient is full of bumps and pitfalls. Aspects of the diagnostic process with potential shortcomings are shown in this graphical illustration. By making these aspects explicit, evidence-based diagnosis can contribute to improved decision making by the dentist for his patient

 

Figure 2
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  		Figure 2 Utility assessment. Example of a visual analogue scale for measuring four health state outcome values. By moving the arrows along a scale between best (100) and worst imaginable (0), the respondent indicates the relative value of the intermediate health outcomes. FN, false negative; FP, false positive; TN, true negative; TP, true positive

 

Figure 3
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  		Figure 3 Simple example of how the options and outcomes of a typical diagnostic problem are modelled in the form of a decision tree. FN, false negative; FP, false positive; Prev, prevalence; Se, sensitivity; Sp, specificity; TN, true negative; TP, true positive

 

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  		Figure 4 The best test strategy and expected utility depending on the prevalence of dentin caries (using utilities of dental students, and diagnostic accuracy from Table 1Go). Below the test threshold of 4% prevalence, the best strategy is to withhold treatment without taking a bitewing radiograph. Above the test–treatment threshold of 57% the best strategy is treatment also without resorting to testing. In the intermediate range of 4–57% the strategy maximizing health is testing and restoring surfaces with a positive test result

 




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