Evidence-based emergency medicine/skills for evidence-based emergency care. Interval likelihood ratios: another advantage for the evidence-based diagnostician.

Abstract

Emergency physicians are often confronted with making diagnostic decisions on the basis of a test result represented on a continuous scale. When the results of continuous data are expressed as binary outcomes using a single cutoff, loss of information and distortion may occur. In this setting, interval likelihood ratios provide a distinct advantage in interpretation over those based on a dichotomized sensitivity and specificity. Dividing the data into intervals uses more of the information contained in the data and allows the clinician to more appropriately interpret the test results and to make valid clinical decisions. This article illustrates the advantages of interval likelihood ratios with examples and demonstrates how to calculate them on the basis of different data formats. Authors and journals need to be encouraged to report the results of studies of performance of diagnostic tests using interval ranges rather than simple dichotomization when the tests involve continuous variables.