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IMA for VTE?
Ischaemia-modified albumin (IMA) once excited interest as an early marker of myocardial infarction, due to apparently high early sensitivity. But the sensitivity of a quantitative test is a function of the diagnostic threshold, and apparently high sensitivity can be achieved by using a low diagnostic threshold and sacrificing specificity. The diagnostic performance of a quantitative test is more appropriately examined by calculating the area under the receiver operating characteristic (AUROC) curve. This is the approach to analysis used by Hogg and colleagues in their evaluation of IMA for diagnosis of venous thromboembolism (VTE). By avoiding the jiggery-pokery associated with sensitivity and specificity, they produce meaningful but disappointing findings that IMA has little diagnostic value for VTE. I wonder what would happen if we analysed D-dimer for VTE in the same way? (see page 455).
Does this patient really need the emergency department?
The vexed question of whether patients with minor or moderate conditions could be managed in other …
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