New patient-oriented summary measure of net total gain in certainty for dichotomous diagnostic tests

OBJECTIVES: To introduce a new, patient-oriented predictive index as a measure of gain in certainty. STUDY DESIGN: Algebraic equations. RESULTS: A new measure is suggested based on error rates in a patient population. The new Predictive Summary Index (PSI) reflects the true total gain in certainty obtained by performing a diagnostic test based on knowledge of disease prevalence, i.e., the overall additional certainty. We show that the overall gain in certainty can be expressed in the form of the following expression: PSI = PPV+NPV-1. PSI is a more comprehensive measure than the post-test probability or the Youden Index (J). The reciprocal of J is interpreted as the number of persons with a given disease who need to be examined in order to detect correctly one person with the disease. The reciprocal of PSI is suggested as the number of persons who need to be examined in order to correctly predict a diagnosis of the disease. CONCLUSION: PSI provides more information than J and the predictive values, making it more appropriate in a clinical setting.