Use of Bayesian statistical approach in diagnosing secondary hypertension.
Bayes's theorem is predominantly used in diagnosing based on the results of various diagnostic tests. This statistical approach is intuitive in differential diagnosis as it explicitly takes into consideration data from medical history, physical examination, laboratory findings and imaging. Bayes's theorem states that the probability of disease occurrence (or occurrence of other outcome) after new information is obtained, called a posteriori probability, depends directly on an a priori probability and the value of likelihood ratio associated with a given test result. This paper describes basic Bayesian analysis in relation to the diagnosis of two types of secondary hypertension; primary aldosteronism and pheochromocytoma. This choice is based on two facts; primary aldosteronism is believed to be the most common and the most commonly detected cause of symptomatic hypertension and pheochromocytoma is thought to have rapid progress and stormy clinical course. This article aims to draw physicians' attention to and increase the knowledge of Bayesian analysis, and to describe its use in everyday clinical decision making. On the basis of this theorem's foundations, the discussion in relation to the issue of differential diagnosis between physicians, their patients, and medical students should also improve. When used in practice, one should be aware, however, of Bayesian analysis limitations concerning the diagnostic test application and limited knowledge of diagnostic test accuracy, and insecure or faulty a priori probability estimates.
Krzych
Lukasz Jerzy
LJ
I Chair and Clinic of Cardiac Surgery, Department of Epidemiology, Medical University of Silesia, Katowice, Poland. l.krzych@wp.pl
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D000328:Adult; D000465:Algorithms; D001291:Attitude of Health Personnel; D001499:Bayes Theorem; D002983:Clinical Competence; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis; D006973:Hypertension / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010673:Pheochromocytoma / Q000175:diagnosis; D012307:Risk Factors