Ruling in or out a source of gastrointestinal bleeding.

Abstract:

BACKGROUND AND AIMS:The search for a source of gastrointestinal bleeding is associated with two distinct approaches of trying to rule in a specific diagnosis or rule out any potential source of bleeding. The study aim was to understand the conceptual differences underlying the two searches. METHODS:The performance of endoscopy as diagnostic test is analyzed in terms of Bayes' formula. RESULTS:The performance of gastrointestinal endoscopy to rule in a suspected lesion is mostly influenced by its underlying specificity. Because the specificity of endoscopy is less likely to be affected by procedural exigencies, the demands on pre-procedural prep and general quality can be more relaxed. In contradistinction, the performance of endoscopy to rule out a suspected bleeding site is mostly influenced by its sensitivity, which can easily be compromised by suboptimal procedural conditions. CONCLUSIONS:Paradoxically, the more urgent, focused, and important search (to rule in a bleeding site), carries less stringent criteria for its execution than the more general and aimless search (to rule out a bleeding site) that frequently ends up just empty handed.

authors

Sonnenberg A

doi

10.1177/2050640614557319

subject

Has Abstract

pub_date

2014-12-01 00:00:00

pages

471-4

issue

6

eissn

2050-6406

issn

2050-6414

pii

10.1177_2050640614557319

journal_volume

2

pub_type

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