Diagnostic Workup Bias in the Evaluation of a Test: Serum Ferritin and Hereditary Hemochromatosis

Two studies report markedly divergent results about the usefulness of serum ferritin in diagnosing iron overload in relatives of patients with hereditary hemochromatosis. One study found the sensitivity of elevated serum ferritin to be 0%; another study found a sensitivity of 100%. Although differen...

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Bibliographic Details
Published in:Medical decision making 1982, Vol.2 (2), p.139-145
Main Authors: Ransohoff, David F., Muir, W. Angus
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biopsy, Needle
Diagnostic Errors
Female
Ferritins - blood
Hemochromatosis - diagnosis
Hemochromatosis - genetics
Humans
Iron - analysis
Liver - analysis
Male
Middle Aged
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Summary:Two studies report markedly divergent results about the usefulness of serum ferritin in diagnosing iron overload in relatives of patients with hereditary hemochromatosis. One study found the sensitivity of elevated serum ferritin to be 0%; another study found a sensitivity of 100%. Although different genetic abnormalities in iron or ferritin metabolism may explain the different results, our examination of these studies suggests that diagnostic workup bias also may explain the difference. In the study reporting a sensitivity of 100%, relatives with normal serum tests may have been excluded from consideration for liver biopsy, thus preventing detection of iron overload. The controversy may provide an empirical illustration of diagnostic workup bias.
ISSN:0272-989X
1552-681X
DOI:10.1177/0272989X8200200205