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Methods Inf Med 1999; 38(01): 31-36
DOI: 10.1055/s-0038-1634145
Original article
Schattauer GmbH

A Rational Request Behavior: The Development of Prediction Instruments regarding Thyroid Function Tests in Primary Care

F. M. H. M. Dupuits
1   Department of Medical Informatics, Maastricht University, The Netherlands
,
P. Pop
2   Diagnostic Coordinating Center, University Hospital Maastricht, The Netherlands
,
A. Hasman
1   Department of Medical Informatics, Maastricht University, The Netherlands
,
H. J. A. Schouten
3   Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
› Author Affiliations
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Publication History

Publication Date:
08 February 2018 (online)

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Abstract:

A prospective study was performed to encourage a rational thyroid-stimulating hormone (TSH) test request behavior of physicians, using prediction instruments. The latter give direct feedback about request adequacy on the basis of pretest probabilities of hyperthyroidism using patients’ signs and symptoms. For instrument design, stepwise logistic regression was used on diagnostic data acquired through questionnaires, answered by 80 physicians and 668 patients for whom physicians requested a TSH test. Instruments were designed for clinical and subclinical hyperthyroidism and for clinical hyperthyroidism alone. Use of the instrument for clinical or subclinical hyperthyroidism on the selected group, at a 5% probability threshold, can result in a 37% reduction of unnecessary TSH test requests. With the instrument for clinical hyperthyroidism at a 5% probability threshold, the number of unnecessary test requests can be reduced by 57%. Therefore, it can be concluded that the instruments can determine TSH test request adequacy and encourage a rational TSH test request behavior of physicians at low pretest probability thresholds.

Keywords:

Hyperthyroidism - Medical Models - Prediction Instruments - Family Medicine
 

  • REFERENCES

  • 1 Crooks J, Murray IPC, Wayne EJ. Statistical methods applied to the clinical diagnosis of thyrotoxicosis. Quart J Med 1959; XXVIII (Suppl. 110) 211-34.
    PubMedGoogle Scholar
  • 2 Crooks J, Wayne EJ, Robb RA. A clinical method of assessing the results of therapy in thyrotoxicosis. Lancet 1960; 20: 397-401.
    PubMedGoogle Scholar
  • 3 Gurney C, Owen SG, Hall R, Roth M, Harper M, Smart GA. Newcastle thyrotoxicosis index. Lancet 1970; 2 7686 1275-8.
    PubMedGoogle Scholar
  • 4 Wayne EJ. Clinical and metabolic studies in thyroid disease (The first of two Lumleian Lectures delivered before the Royal College of Physicians of London on April 14 and 16, 1959). Br Med J 1960; 2: 1-11.
    PubMedGoogle Scholar
  • 5 Billewicz WZ, Chapman RS, Crooks J. et al. Statistical methods applied to the diagnosis of hypothyroidism. Quart J Med 1969; XXXVIII (Suppl. 150) 255-66.
    PubMedGoogle Scholar
  • 6 Wayne EJ. Clinical and metabolic studies in thyroid disease (The second of two Lumleian Lectures delivered before the Royal College of Physicians of London on April 14 and 16, 1959). Br Med J 1960; 9: 78-90.
    PubMedGoogle Scholar
  • 7 Bommer M, Eversmann T, Pickardt R, Leonhardt A, Naber D. Psychopathological and neuropsychological symptoms in patients with subclinical and remitted hyperthyroidism. Klin Wochenschr 1990; 68 (Suppl. 11) 552-8.
    CrossrefPubMedGoogle Scholar
  • 8 Mudde AH. Effects of Subclinical Hyperthyroidism on Bone and Heart [Doctoral Thesis at the Maastricht University]. Maastricht: University Press Maastricht (UPM); 1993
    Google Scholar
  • 9 Ross DS, Neer RM, Ridgway EC, Daniels GH. Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thyroid axis with L-thyroxine. Am J Med 1987; 82: 1167-70.
    CrossrefPubMedGoogle Scholar
  • 10 Schlote B, Schaaf L, Schmidt R. et al. Mental and physical state in subclinical hyperthyroidism – Investigations in a normal working population. Biol Psych 1992; 32 (Suppl. 01) 48-56.
    CrossrefPubMedGoogle Scholar
  • 11 Wiersinga WM. Subclinical hypothyroidism and hyperthyroidism – I. Prevalence and clinical relevance. Neth J Med 1995; 46 (Suppl. 04) 197-204.
    CrossrefPubMedGoogle Scholar
  • 12 Lentner C. Geigy Scientific Tables – Volume 2: Introduction to Statistics, Statistical Tables, Mathematical Formulae . Basel: Ciba-Geigy Limited; 1982
    Google Scholar
  • 13 Miller RG. The Jackknife – A review. Biometrika 1974; 61: 1-15.
    PubMedGoogle Scholar
  • 14 Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med 1979; 300: 1350-8.
    CrossrefPubMedGoogle Scholar
  • 15 Aronson MD. Heterophil antibody in adults with sore throat-Frequency and clinical presentation. Ann Int Med 1982; 96: 505-8.
    CrossrefPubMedGoogle Scholar
  • 16 Griner PF. Cholelithiasis. In: Griner PF, Panzer RJ, Greenland P. eds. Clinical Diagnosis and the Laboratory: Logical Strategies for Common Medical Problems . Chicago: Chicago Year Book Medical Publishers; 1986: 247-55.
    Google Scholar
  • 17 Bagchi N, Brown TR, Parish RF. Thyroid dysfunction in adults over age 55 years – A study in an urban US community. Arch Intern Med 1990; 150: 785-7.
    CrossrefPubMedGoogle Scholar
  • 18 Davies AB, Williams I, John R, Hall R, Scanlon MF. Diagnostic value of thyrotropin releasing hormone tests in elderly patients with atrial fibrillation. Br Med J 1985; 291: 773-6.
    CrossrefPubMedGoogle Scholar
  • 19 Finucane P, Rudra T, Church H. et al. Thyroid function tests in elderly patients with and without an acute illness. Age and Ageing 1989; 18: 398-402.
    CrossrefPubMedGoogle Scholar
  • 20 Francis T, Wartofsky L. Common thyroid disorders in the elderly. Postgrad Med 1992; 92 (Suppl. 03) 225-30 233-6.
    CrossrefPubMedGoogle Scholar
  • 21 Levy EG. Thyroid disease in the elderly. Med Clin North Am 1991; 75 1 – Special on Thyroid Diseases 151-67.
    CrossrefPubMedGoogle Scholar
  • 22 Sawin CT, Castelli WP, Hershman JM, McNamara P, Bacharach P. The aging thyroid – Thyroid deficiency in the Framing-ham study. Arch Intern Med 1985; 145: 1386-8.
    CrossrefPubMedGoogle Scholar
  • 23 Dupuits FMHM. The use of the Arden Syntax for MLMs in HIOS+, a decision support system for general practitioners in The Netherlands. Comp Biol Med 1994; 24 (Suppl. 05) 405-10.
    CrossrefPubMedGoogle Scholar
  • 24 Dupuits FMHM, Hasman A. Evaluation of a decision support system in a medical environment. Int J Bio-Med Comp 1995; 38: 155-65.
    CrossrefPubMedGoogle Scholar
  • 25 Dupuits FMHM, Hermsen JT, Oosterhuis WP, Winkens RAG. BODE, een transmuraal laboratoriumaanvraag informatiesys-teem. In: Sollet PCGM. ed. Symposiumverslag van het Electronisch Medisch Dossier Congres 1997 – Huisarts, Specialist en het Elektronische Medisch Dossier: ‘Werken aan transmurale zorg’ (EMD 97) . Rotterdam: Erasmus Universiteit Rotterdam; 1997: P113-P6.
    Google Scholar