Diagnostic Accuracy— A New Approach to Its Evaluation

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Abstract
Previous calculations of clinical diagnostic accuracy have not taken all possible types of error into account. A new method is presented in which clinical diagnostic accuracy is measured in terms of an index of suspicion and an index of diagnostic accuracy. These indices not only demonstrate the degree of clinical awareness of a disease entity, but also provide information regarding the degree of inaccuracy and why the inaccuracy occurs. This new method of assessing clinical diagnostic acumen is applied to a study of 1,059 clinical diagnoses of basal cell epitheliomas occurring in a consecutive series of 3010 histologically examined skin tumors seen in the Oncology Section of the Skin and Cancer Unit over a five year period. The results indicate that while the index of suspicion of this group of physicians was good, their diagnostic accuracy was such that almost one in four was incorrect. Need for improving clinical diagnostic ability and for examining skin tumors histopathologically is stressed.

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