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Estimating the True Accuracy of Diagnostic Tests for Dengue Infection Using Bayesian Latent Class Models

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Pan-Ngum, W, Blacksell, SD, Lubell, Y, Pukrittayakamee, S, Bailey, MS, de Silva, HJ, Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200, Day, NP, White, LJ and Limmathurotsakul, D (2013) 'Estimating the True Accuracy of Diagnostic Tests for Dengue Infection Using Bayesian Latent Class Models'. PLoS ONE, Vol 8, Issue 1, e50765.

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Abstract

Background

Accuracy of rapid diagnostic tests for dengue infection has been repeatedly estimated by comparing those tests with reference assays. We hypothesized that those estimates might be inaccurate if the accuracy of the reference assays is not perfect. Here, we investigated this using statistical modeling.

Methods/Principal Findings

Data from a cohort study of 549 patients suspected of dengue infection presenting at Colombo North Teaching Hospital, Ragama, Sri Lanka, that described the application of our reference assay (a combination of Dengue IgM antibody capture ELISA and IgG antibody capture ELISA) and of three rapid diagnostic tests (Panbio NS1 antigen, IgM antibody and IgG antibody rapid immunochromatographic cassette tests) were re-evaluated using Bayesian latent class models (LCMs). The estimated sensitivity and specificity of the reference assay were 62.0% and 99.6%, respectively. Prevalence of dengue infection (24.3%), and sensitivities and specificities of the Panbio NS1 (45.9% and 97.9%), IgM (54.5% and 95.5%) and IgG (62.1% and 84.5%) estimated by Bayesian LCMs were significantly different from those estimated by assuming that the reference assay was perfect. Sensitivity, specificity, PPV and NPV for a combination of NS1, IgM and IgG cassette tests on admission samples were 87.0%, 82.8%, 62.0% and 95.2%, respectively.

Conclusions

Our reference assay is an imperfect gold standard. In our setting, the combination of NS1, IgM and IgG rapid diagnostic tests could be used on admission to rule out dengue infection with a high level of accuracy (NPV 95.2%). Further evaluation of rapid diagnostic tests for dengue infection should include the use of appropriate statistical models.

Item Type: Article
Subjects: WA Public Health > Preventive Medicine > WA 243 Diagnositic services
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WB Practice of Medicine > Diagnosis > General Diagnosis > WB 141 General works
WC Communicable Diseases > Virus Diseases > Infectious Mononucleosis. Arbovirus Infections > WC 528 Dengue
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0050765
Depositing User: Annmarie Hand
Date Deposited: 11 Dec 2013 14:52
Last Modified: 06 Feb 2018 13:06
URI: https://archive.lstmed.ac.uk/id/eprint/3507

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