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Use of Liver-Spleen Scans to Detect Metastases

Richard M. Allman, MD; Earl P. Steinberg, MD, MPP; Jeanne C. Keruly, RN; Peter E. Dans, MD

JAMA. 1985;254(2):246-248.

Abstract
To gain insight into diagnostic test use, we interviewed 42 physicians who ordered 62 liver-spleen scans to detect possible metastases. Before receiving the actual scan results, physicians gave (1) pretest probability estimates for liver metastasis; (2) probability estimates and management plans given the most common scan results; and (3) probabilities above and below which they would stop the diagnostic workup (their decision thresholds). After learning the actual scan results, physicians gave their posttest probabilities and management plans. Thirteen physicians (31%) desired absolute certainty to rule in metastasis. Fifty percent planned further evaluations even when probability estimates of metastasis reached one of their probability targets for ending the workup. Greater attention to decision thresholds may improve physicians' understanding of their tolerance for diagnostic uncertainty and the ability of diagnostic tests to reduce it.

(JAMA 1985;254:246-248)

Author Affiliations
From the Division of Internal Medicine (Drs Allman, Steinberg, and Dans) and the Office of Medical Practice Evaluation (Drs Steinberg and Dans and Ms Keruly), Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore.

Footnotes
Presented as a poster at the national meeting of the American Federation for Clinical Research, Washington, DC, May 6, 1984.

Reprint requests to the Office of Medical Practice Evaluation, Osler 624, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21205 (Dr Dans).

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