The Measurement of Performance in Probabilistic Diagnosis

Attention is focused on one important aspect of good performance in probabilistic diagnosis, the »reliability« (external validity) of probabilistic assertions: a diagnostic alternative claimed to be 90% certain, say, must occur neither more nor less than nine times out of ten on the average. Statistical measures are offered by which departures from such perfect reliability can be estimated, and statistical tests are developed in order to test the hypothesis of perfect reliability. The specific reliability defects looked for include overconfident diagnoses and so-called size bias (common diseases being over diagnosed). Reliability is contrasted with discriminatory power and other performance aspects. The illustrative data derive from a study of computer-aided diagnosis of the acute abdomen.

Die Arbeit behandelt einen wichtigen Aspekt der Leistungsgüte bei der probabilistischen Diagnose, nämlich die »Reliabilität« (externe Gültigkeit) der probabilistischen Behauptungen im folgenden Sinne: eine z.B. als 90% sicher angesehene diagnostische Alternative darf im Durchschnitt weder häufiger noch seltener als in neun von zehn Fällen vorliegen. Die Verfasser bieten statistische Methoden an, mit deren Hilfe Abweichungen von einer solchen perfekten Zuverlässigkeit geschätzt werden können, sowie Verfahren für die Prüfung der Hypothese perfekter Zuverlässigkeit. Zu den spezifischen Mängeln an Zuverlässigkeit, die hier behandelt werden, gehören »übertrieben zuversichtliche« Diagnosen und der sogenannte »size bias« (häufige Krankheiten werden überdiagnostiziert). Der Zuverlässigkeit in diesem Sinne werden Diskriminanzvermögen und andere Leistungsaspekte gegenübergesteht. Die illustrierenden Daten entstammen einer Studie über die computerunterstützte Diagnose bei akuten Bauchschmerzen.

Keywords

Computer-aided Diagnosis - External Validity - Reliability - Overconfidence - Size Bias - Graphical Reliability Analysis

Schlüssel-Wörter

Computerunterstützte Diagnose - externe Gültigkeit - Reliabilität - Overconfidence - Size Bias - graphische Reliabilitätsanalyse

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