How to Determine the Accuracy of an Alternative Diagnostic Test when It Is Actually Better than the Reference Tests: A Re-Evaluation of Diagnostic Tests for Scrub Typhus Using Bayesian LCMs

The indirect immunofluorescence assay (IFA) is considered a reference test for scrub typhus. Recently, the Scrub Typhus Infection Criteria (STIC; a combination of culture, PCR assays and IFA IgM) were proposed as a reference standard for evaluating alternative diagnostic tests. Here, we use Bayesian...

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Bibliographic Details
Published in:PloS one 2015-05, Vol.10 (5), p.e0114930-e0114930
Main Authors: Lim, Cherry, Paris, Daniel H, Blacksell, Stuart D, Laongnualpanich, Achara, Kantipong, Pacharee, Chierakul, Wirongrong, Wuthiekanun, Vanaporn, Day, Nicholas P J, Cooper, Ben S, Limmathurotsakul, Direk
Format: Article
Language:English
Subjects:
Accuracy
Adolescent
Adult
Aged
Aged, 80 and over
Antigens
Assaying
Bacterial infections
Bayes Theorem
Bayesian analysis
Blood culture
Blood tests
Care and treatment
Causes of
Clinical medicine
Culture
Diagnosis
Diagnostic systems
Diagnostic tests
Diagnostic Tests, Routine - standards
Enzymes
Ethics
Evaluation
Female
Fever
Fluorescent Antibody Technique, Indirect
Health aspects
Hospitals
Humans
Illnesses
Immunoassay
Immunofluorescence
Immunoglobulin M
Immunoglobulin M - analysis
Infections
Male
Mathematical models
Medical diagnosis
Medicine
Methods
Middle Aged
Orientia tsutsugamushi
Patients
Physicians
Polymerase Chain Reaction
Public health
Scrub typhus
Scrub Typhus - diagnosis
Sensitivity
Sensitivity and Specificity
Statistical analysis
Statistical models
Tropical diseases
Typhus
Young Adult
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Summary:The indirect immunofluorescence assay (IFA) is considered a reference test for scrub typhus. Recently, the Scrub Typhus Infection Criteria (STIC; a combination of culture, PCR assays and IFA IgM) were proposed as a reference standard for evaluating alternative diagnostic tests. Here, we use Bayesian latent class models (LCMs) to estimate the true accuracy of each diagnostic test, and of STIC, for diagnosing scrub typhus. Data from 161 patients with undifferentiated fever were re-evaluated using Bayesian LCMs. Every patient was evaluated for the presence of an eschar, and tested with blood culture for Orientia tsutsugamushi, three different PCR assays, IFA IgM, and the Panbio IgM immunochromatographic test (ICT). True sensitivity and specificity of culture (24.4% and 100%), 56kDa PCR assay (56.8% and 98.4%), 47kDa PCR assay (63.2% and 96.1%), groEL PCR assay (71.4% and 93.0%), IFA IgM (70.0% and 83.8%), PanBio IgM ICT (72.8% and 96.8%), presence of eschar (42.7% and 98.9%) and STIC (90.5% and 82.5%) estimated by Bayesian LCM were considerably different from those obtained when using STIC as a reference standard. The IgM ICT had comparable sensitivity and significantly higher specificity compared to IFA (p=0.34 and p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0114930