Medical test

Medical test
Intervention
X-ray of a hand. X-rays are a common medical test.
MeSH	D019937

A medical test is a kind of medical procedure performed to detect, diagnose, or monitor diseases, disease processes, susceptibility, and determine a course of treatment.

Types of tests

By utilization

Medical tests can be classified by what the test result will be used for, mainly including usage for diagnosis, screening or evaluation, as separately detailed below.

Diagnostic

Main article: Diagnostic test

Lung scintigraphy evaluating lung cancer

A diagnostic test is a procedure performed to confirm, or determine the presence of disease in an individual suspected of having the disease, usually following the report of symptoms, or based on the results of other medical tests.^[1][2] Such tests include:

• Utilizing nuclear medicine techniques to examine a patient having a lymphoma.
• Measuring the blood sugar in a person suspected of having diabetes mellitus, after periods of increased urination.
• Taking a complete blood count of an individual experiencing a high fever, to check for a bacterial infection.^[1]
• Monitoring electrocardiogram readings on a patient suffering chest pain, to diagnose or determine any heart irregularities.^[3]

Screening

Main article: Screening (medicine)

A screening is a medical test or series used to detect or predict the presence of disease in individuals at risk for disease within a defined group, such as a population, family, or workforce.^{[4] [5]} Screenings may be performed to monitor disease prevalence, manage epidemiology, aid in prevention, or strictly for statistical purposes.^[6]

Examples of screenings include measuring the level of TSH in the blood of a newborn infant as part of newborn screening for congenital hypothyroidism,^[7] checking for Lung cancer in non-smoking individuals who are exposed to second-hand smoke in an unregulated working environment, and Pap smear screening for prevention or early detection of cervical cancer.

Monitoring

Main article: Monitoring (medicine)

Some medical tests are used to monitor the progress of, or response to medical treatment.

By method

Most test methods can be classified into either of the following broad groups:

• Tests performed in a physical examination
• Questions asked in the taking of a medical history of an individual.
• Radiologic tests, in which, for example, x-rays are used to form an image of a body target.
• Microbiological culture, which determines the presence or absence of microbes in a sample from the body, usually targeted at detecting pathogenic bacteria.
• Genetic testing

By sample location

Tests can be classified according to the location of the sample being tested, including:

• Blood tests
• Urine tests

Accuracy and precision

Main article: Accuracy and precision

• Accuracy of a laboratory test is its correspondence with the true value. Accuracy is maximized by calibrating laboratory equipment with reference material and by participation in external quality control programs.

• Precision is a measure of tests reproducibility when repeated on the same sample. An imprecise test is one that yield widely varying results on repeated measurement. The precision is monitored in laboratory by using control material.

Detection and/or quantification

Tests performed in a physical examination are usually aimed at detecting a symptom or sign, and in these cases, a test that detects a symptom or sign is designated a positive test, and a test that indicated absence of a symptom or sign is designated a negative test, as further detailed in separate section below.

A quantification of a target substance, a cell type or another specific entity is a common output of, for example, most blood tests. This is not only answering if a target entity is present or absent, but also how much is present. In blood tests, the quantification is relatively well specified, such as given in mass concentration, while most other tests may be quantifications as well although less specified, such as a sign of being "very pale" rather than "slightly pale". Similarly, radiologic images are technically quantifications of radiologic opacity of tissues.

Especially in the taking of a medical history, there is no clear limit between a detecting or quantifying test versus rather descriptive information of an individual. For example, questions regarding the occupation or social life of an individual may be regarded as tests that can be regarded as positive or negative for the presence of various risk factors, or they may be regarded as "merely" descriptive, although the latter may be at least as clinically important.

Positive or negative

The result of a test aimed at detection of an entity may be positive or negative: this has nothing to do with a bad prognosis, but rather means that the test worked or not, and a certain parameter that was evaluated was present or not. For example, a negative screening test for breast cancer means that no sign of breast cancer could be found (which is in fact very positive for the patient).

The classification of tests into either positive or negative gives a binary classification, with resultant ability to perform bayesian probability and performance metrics of tests, including calculations of sensitivity and specificity.

Continuous values

Tests whose results are of continuous values, such as most blood values, can be interpreted as they are, or they can be converted to a binary ones by defining a cutoff value, with test results being designated as positive or negative depending on whether the resultant value is higher or lower than the cutoff.

Interpretation

Further information: Pre- and post-test probability

In the finding of a pathognomonic sign or symptom it is almost certain that the target condition is present, and in the absence of finding a sine qua non sign or symptom it is almost certain that the target condition is absent. In reality, however, the subjective probability of the presence of a condition is never exactly 100% or 0%, so tests are rather aimed at estimating a post-test probability of a condition or other entity.

Most diagnostic tests basically use a reference group to establish performance data such as predictive values, likelihood ratios and relative risks, which are then used to interpret the post-test probability for an individual.

In monitoring tests of an individual, the test results from previous tests on that individual may be used as a reference to interpret subsequent tests.

Risks

Some medical testing procedures have health risks, and even require general anesthesia, such as the mediastinoscopy.^[8] Other tests, such as the blood test or pap smear have little to no direct risks.^[9] Medical tests may also have indirect risks, such as the stress of testing, and riskier tests may be required as follow-up for a (potentially) false positive test result. Consult the physician prescribing any test for further information.

Indications

Each test has its own indications and contraindications, but in a simplified fashion, how much a test is indicated for an individual depends largely on its net benefit for that individual, which may roughly be estimated by:

$b_n = \Delta p \times r_i \times ( b_i - h_i ) - h_t$

, where:

• b_n is the net benefit of performing a test
• Λp is the absolute difference between pre- and posttest probability of conditions (such as diseases) that the test is expected to achieve. A major factor for such an absolute difference is the power of the test itself, such as can be described in terms of, for example, sensitivity and specificity or likelihood ratio. Another factor is the pre-test probability, with a lower pre-test probability resulting in a lower absolute difference, with the consequence that even very powerful tests achieve a low absolute difference for very unlikely conditions in an individual (such as rare diseases in the absence of any other indicating sign), but on the other hand, that even tests with low power can make a great difference for highly suspected conditions. The probabilities in this sense may also need to be considered in context of conditions that are not primary targets of the test, such as profile-relative probabilities in a differential diagnostic procedure.
• r_i is the rate of how much probability differences are expected to result in changes in interventions (such as a change from "no treatment" to "administration of low-dose medical treatment"). For example, if the only expected effect of a medical test is to make one disease more likely compared to another, but the two diseases have the same treatment (or neither can be treated), then, this factor is very low and the test is probably without value for the individual in this aspect.
• b_i is the benefit of changes in interventions for the individual
• h_i is the harm of changes in interventions for the individual, such as side effects of medical treatment
• h_t is the harm caused by the test itself

Additional factors that influence a decision whether a medical test should be performed or not include: cost of the test, availability of additional tests, potential interference with subsequent test (such as an abdominal palpation potentially inducing intestinal activity whose sounds interfere with a subsequent abdominal auscultation), time taken for the test or other practical or administrative aspects. The possible benefits of a diagnostic test may also be weighed against the costs of unnecessary tests and resulting unnecessary follow-up and possibly even unnecessary treatment of incidental findings.^[10] Also, even if not beneficial for the individual being tested, the results may be useful for the establishment of statistics in order to improve health care for other individuals.

Standard for the reporting and assessment of medical tests

The QUADAS-2 revision is available.^[11]

See also

• Blood culture
• Blood test
• Diagnostic test
• Genetic testing
• Nailbed assessment
• Screening (medicine)
• Test panel
• Gold standard (test)

References

1. ^ ^{a b} Al-Gwaiz LA, Babay HH (2007). "The diagnostic value of absolute neutrophil count, band count and morphological changes of neutrophils in predicting bacterial infections". Med Princ Pract. 16 (5): 344–347. doi:10.1159/000104806. PMID 17709921. 
2. ^ Harvard.edu
   Guide to Diagnostic Tests from Harvard Health
3. ^ Harvard.edu
4. ^ Ratcliffe JM, Halperin WE, Frazier TM, Sundin DS, Delaney L, Hornung RW (1986). "The prevalence of screening: a report from the National Institute of Occupational Safety and the Health National Occupational Hazard Survey". Journal of Occupational Medicine 28 (10): 906–912. doi:10.1097/00043764-198610000-00003. PMID 3021937. 
5. ^ Osha.gov
   US Dept. of Labor - Occupational Safety and Health Admin.
6. ^ Murthy LI, Halperin WE (1995). "Medical Screening and Biological Monitoring: A guide to the literature for physicians". Journal of Occupational and Environmental Medicine 37 (2): 170–184. doi:10.1097/00043764-199502000-00016. PMID 7655958. 
7. ^ Moltz KC, Postellon DC (1994). "Congenital hypothyroidism and mental development". Comprehensive Therapy 20 (6): 342–346. PMID 8062543. 
8. ^ Harvard.edu
9. ^ Harvard.edu
10. ^ Jarvik J, Hollingworth W, Martin B, Emerson S, Gray D, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan S, Kreuter W, Deyo R (2003). "Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial". JAMA 289 (21): 2810–8. doi:10.1001/jama.289.21.2810. PMID 12783911. 
11. ^ Whiting, Penny F.; Anne W.S. Rutjes, Marie E. Westwood, Susan Mallett, Jonathan J. Deeks, Johannes B. Reitsma, Mariska M.G. Leeflang, Jonathan A.C. Sterne, Patrick M.M. Bossuyt, the QUADAS-2 Group (2011-10-18). "QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies". Annals of Internal Medicine 155 (8): 529–536. doi:10.1059/0003-4819-155-8-201110180-00009. http://www.annals.org/content/155/8/529.abstract. Retrieved 2011-10-18.