Parametric methods for estimating covariate-dependent reference limits

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Abstract
Age-specific reference limits are required for many clinical laboratory measurements. Statistical assessment of calculated intervals must be performed to obtain reliable reference limits. When parametric, covariate-dependent limits are derived, normal distribution theory usually is applied due to its mathematical simplicity and relative ease of fitting. However, it is not always possible to transform data and achieve a normal distribution. Therefore, models other than those based on normal distribution theory are needed. Generalized linear model theory offers one such alternative. Regardless of the statistical model used, the assumptions behind the model should always be examined.