|Symptoms||Increased Disease Probability (Positive Likelihood Ratio)|
|Tearing/Ripping Pain||10.8× (5.2-22.0)|
|Migrating pain||7.6× (3.6-16.0)|
|Sudden Chest Pain||2.6× (2.0-3.5)|
|Hx of Hypertension||1.5× (0.8-3.0)|
|Signs on Physical Exam||Increased Disease Probability (Positive Likelihood Ratio)|
|Focal Neurologic Deficit||33.0× (2.0-549.0)|
|Diastolic Heart Murmur||4.9× (0.6-40.0)|
|Pulse Deficit||2.7× (0.7-9.8)|
|Lab and Study Findings||Increased Disease Probability (Positive Likelihood Ratio)|
|Enlarged Aorta or Wide Mediastinum||3.4× (2.4-4.8)|
|LVH on Admission EKG||3.2× (1.5-6.8)|
|Symptoms||Decreased Disease Probability (Negative Likelihood Ratio)|
|Sudden Chest Pain||0.3× (0.2-0.4)|
|History of Hypertension||0.4× (0.3-0.6)|
|Tearing/Ripping Pain||0.4× (0.3-0.5)|
|Migrating Pain||0.6× (0.5-0.7)|
|Signs on Physical Exam||Decreased Disease Probability (Negative Likelihood Ratio)|
|Pulse deficit||0.63× (0.4-1.0)|
|Focal Neuro deficit||0.87× (0.8-0.9)|
|Diastolic murmur||1.1× (0.6-1.7)|
|Lab and Study Findings||Decreased Disease Probability (Negative Likelihood Ratio)|
|Enlarge aorta or wide mediastinum||0.13× (0.02-1.00)*|
|LVH on admission EKG||0.84× (0.7-0.9)|
Caveats: Other studies were omitted due to methodological limitations.
Author: Rodrigo Kong, MD
Published/Updated: February 22, 2012
LR, pretest probability and posttest (or posterior) probability are daunting terms that describe simple concepts that we all intuitively understand.
Let's start with pretest probability: that's just a fancy term for my initial impression, before we perform whatever test it is that we're going to use.
For example, a patient with prior stents comes in sweating and clutching his chest in agony, I have a pretty high suspicion that he's having an MI – let's say, 60%. That is my pretest probability.
He immediately gets an ECG (known here as the "test") showing an obvious STEMI.
Now, I know there are some STEMI mimics, so I'm not quite 100%, but based on my experience I'm 99.5% sure that he's having an MI right now. This is my posttest probability - the new impression I have that the patient has the disease after we did our test.
And likelihood ration? That's just the name for the statistical tool that converted the pretest probability to the posttest probability - it's just a mathematical description of the strength of that test.
Using an online calculator, that means the LR+ that got me from 60% to 99.5% is 145, which is about as high an LR you can get (and the actual LR for an emergency physician who thinks an ECG shows an obvious STEMI).
(Thank you to Seth Trueger, MD for this explanation!)
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