Certainty in an uncertain world: A clinicians' viewpoint of sensitivity and precision

Abstract

Clinical practice is evolving as research evolves from the bench to the bedside. Similarly, analytical technologies are improving on an annual basis. Rightly or wrongly, increased emphasis is now placed by clinicians on such investigations to the detriment of clinical history and examination. As people live longer, the prevalence of long-term conditions such as thyroid disease, cardiovascular disease and malignancies is increasing. Clinical biochemistry assays play an important part in the management (screening, diagnosis, prognosis and monitoring) of such conditions. This is reflected in the UK since 2004 by the primary care contract where over 100 of the 550 clinical points depend on clinical biochemistry assay results. Inter-assay results may differ due to bias, precision, assay specificity and assay sensitivity. To date, little emphasis has been placed on the potential clinical effect of precision. This presentation will explore the effect that assay precision can have on the management of important long-term conditions such as thyroid disease, cardiovascular disease and malignancies.

Keywords

• functional sensitivity
• imprecision
• prostatespecific antigen
• thyroid stimulating hormone
• troponin
• au3000i