title: A critical evaluation of the clinical diagnosis of anemia.
abstract: Three physicians independently assessed whether 180 medical or surgical inpatients were anemic. The assessments were based on inspection of skin, nail beds, and conjunctivae. The observers made a positive diagnosis with significantly different frequency. Overall agreements between pairs of observers were 0.76-0.87. Agreement on negative diagnoses was higher than agreement on positive diagnoses. The overall agreements were adjusted for chance agreement, and kappa values which ranged from 0.23-0.47 were obtained. The overall accuracy of the clinical diagnoses was determined with the blood hemoglobin concentration as the "true" standard. For the three observers, the overall accuracy ranged from 0.78-0.79, the predictive value of a positive diagnosis ranged from 0.51-0.61, the predictive value of a negative diagnosis ranged from 0.81-0.84, the sensitivity ranged from 0.27-0.44, and the specificity ranged from 0.88-0.95. For each observer, the probability of detecting anemia was estimated as a function of the blood hemoglobin concentration. Compared with the "true" diagnosis, the observers were reluctant to call a patient anemic, and even in patients with the lowest blood hemoglobin concentrations, the expected probability of detecting anemia did not exceed 0.75.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000175:diagnosis*; D005069:Evaluation Studies as Topic; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011336:Probability; D012044:Regression Analysis
chemical_list: D006454:Hemoglobins