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Intensive Care Medicine

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01.12.2006 | Original

Variable performance of weaning-predictor tests: role of Bayes' theorem and spectrum and test-referral bias

verfasst von: Martin J. Tobin, Amal Jubran

Erschienen in: Intensive Care Medicine | Ausgabe 12/2006

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Abstract

Objective

We examined whether variation in reported reliability of the frequency-to-tidal volume ratio (f/V_T) in predicting weaning success is explained by spectrum and test-referral bias, as reflected by variation in pretest probability of success.

Design

Two authors extracted data from all studies on reliability of f/V_T as a weaning predictor.

Results

Prevalence of successful weaning in studies of f/V_T revealed significant heterogeneity; mean success rate was 0.75. The heterogeneity and high success rate reflects occurrence of spectrum bias, suggested by the lower value of f/V_T in subsequent studies than in the original report (77.4 vs. 89.1) and test-referral bias, suggested by lower specificity of f/V_T in subsequent studies than in the original report (0.52 vs. 0.64). When data from studies in the ACCP Task Force's meta-analysis of studies on f/V_T were entered into a Bayesian model with pretest probability (prevalence of success) as the operating point, observed posttest probabilities were closely correlated with values predicted by the original report on f/V_T: positive-predictive value r = 0.86 and negative-predictive value r = 0.82. Average sensitivity, the most precise measure of screening-test reliability, was 0.87 ± 0.14 and average specificity 0.52 ± 0.26.

Conclusions

Much of the heterogeneity in performance of f/V_T can be explained by variation in pretest probability of successful outcome, which may be secondary to spectrum and test-referral bias. The average sensitivity of 0.87 indicates that f/V_T is a reliable screening test for successful weaning.

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Titel: Variable performance of weaning-predictor tests: role of Bayes' theorem and spectrum and test-referral bias
verfasst von: Martin J. Tobin
Amal Jubran
Publikationsdatum: 01.12.2006
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 12/2006
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-006-0439-4

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Variable performance of weaning-predictor tests: role of Bayes' theorem and spectrum and test-referral bias

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