THE 2-by-2 TABLE: Its concepts

The 2-by-2 table

Application:
To judge the usefulness of a screening or diagnostic test for a particular
disease

To assess the quality of a diagnostic test:

validity and reliability
sensitivity and specificity
positive and negative predictive values

When using quantitative test resultssuch as measurements

of fasting glucose, serum cholesterol, or hematocrit levels
the physician will also need to know the accuracy and
precision of the measurement as well as the normal
reference values
 Validity
Validity:
the extent to which it actually tests what it claims to testin
other words, how closely its results correspond to the real
state of affairs
Validity is synonymous with accuracy
Accuracy is the ability of a test to produce a true value of the
measurements and true classifications for the samples under
study
 Reliability
Reliability:
Reliability is synonymous with repeatability and
reproducibility; it is the level of agreement between
repeated measurements of the same variable. Hence, it is
also called testretest reliability
Reliability corresponds to precision
Precision is the extent to which random variability is absent
from a test result.
2-by-2 table
 Sensitivity and specificity
Sensitivity:
Ability to detect people who do have the disease
A sensitive test is obviously required in situations in which a
false negative result has serious consequences.
High sensitivity is required of tests used to screen donated
blood for HIV, for cytologic screening tests (Pap smears) for
cervical cancer, and for mammograms
Very sensitive tests are therefore used for screening or for ruling
out disease; if the result of a highly sensitive test is negative,
it allows the disease to be ruled out with confidence
 Sensitivity and specificity
Specificity:
Ability to detect people who do not have the disease
High specificity is required in situations in which the
consequences of a false positive diagnosis are serious
If the result of a highly specific test is positive, the disease is
almost certainly present
Very specific tests are therefore appropriate for confirming or
ruling in the existence of a disease
If the result of a highly specific test is positive, the disease is
almost certainly present
 Sensitivity and specificity

In clinical practice, sensitivity and specificity

are inversely related: an increase in one
causes a decrease in the other

Sensitivity and specificity are both measures

of a tests validity i.e. its ability to correctly
detect people with or without the disease in
question
 False-positive and False-negative
rates
False-positive rate:
False-positive rate= B/ (B+D)
False-negative rate:
False-negative rate = C/ (A+C)
Receiver Operating Characteristic curve
 Positive-predictive value
The positive predictive value (PPV) of a test is the proportion of
positive results that are true positives, that is, the likelihood that
a person with a positive test result truly has the disease
 Negative-predictive value
The negative predictive value (NPV) of a test is the proportion of
negative results that are true negatives, that is, the likelihood
that a person with a negative result truly does not have the
disease
Cut-off points
TYPES OF VARIABLES
 Nominal variables
Naming or categorical variables
For example, blood groups,
occupations
Variables are assigned a numerical
value
 Dichotomous variables
Binary variables
Variables have only two values
For example, normal/abnormal;
female/male; living/dead
 Ordinal variables
Ranked variables
Characterized in terms of more than
two values and have a clearly implied
direction from better to worse
For example, respiratory distress
(mild/moderate/severe); abnormal
murmurs (1+ to 6+)
 Continuous variables
Dimensional variables
Medically important data
For example, heights, weights,
serum glucose levels, systolic and
diastolic blood pressures
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