A better confidence interval for the sensitivity at a fixed level of specificity for diagnostic tests with continuous endpoints

Abstract

For a diagnostic test with continuous measurement, it is often important to construct confidence intervals for the sensitivity at a fixed level of specificity. Bootstrap-based confidence intervals were shown to have good performance as compared to others, and the one by Zhou and Qin (2005) was recommended as the best existing confidence interval, named the BTII interval. We propose two new confidence intervals based on the profile variance method and conduct extensive simulation studies to compare the proposed intervals and the BTII intervals under a wide range of conditions. An example from a medical study on severe head trauma is used to illustrate application of the new intervals. The new proposed intervals generally have better performance than the BTII interval.

Keywords

confidence intervals diagnostic test profile variance sensitivity specificity

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References

Shapiro

. The interpretation of diagnostic tests. Stat Methods Med Res 1999; 8: 113–134.

Linnet

. Comparison of quantitative diagnostic tests: type I error, power, and sample size. Stat Med 1987; 6: 147–158.

Platt

Hanley

Yang

. Bootstrap confidence intervals for the sensitivity of a quantitative diagnostic test. Stat Med 2000; 19: 313–322.

Zhou

Qin

. Improved confidence intervals for the sensitivity at a fixed level of specificity of a continuous-scale diagnostic test. Stat Med 2005; 24: 465–477.

Wilson

. Probable inference, the law of succession, and statistical inference. J Am Stat Assoc 1927; 22: 209–212.

Lee

. A better confidence interval for kappa () on measuring agreement between two raters with binary outcomes. J Comput Graph Stat 1994; 3: 301–321.

Bickel

Doksum

. Mathematical statistics, San Francisco: Holden-Day, Inc, 1977.

Agresti

Coull

. Approximate is better than “exact” for interval estimation of binomial proportions. Am Stat 1998; 52: 119–126.

Hans

Albert

Born

. Derivation of a bioclinical prognostic index in severe head injury. Intensive Care Medicine 1985; 11: 186–191.

10.

Zhou

X-H

Obuchowski

McClish

. Statistical methods in diagnostic medicine, Hoboken, NJ: John Wiley & Sons, Inc, 2011.

11.

Shan

Wang

. ExactCIdiff: an R package for computing exact confidence intervals for the difference of two proportions. R Journal 2013; 5: 62–71.

12.

Qin

Hsu

Zhou

. New confidence intervals for the difference between two sensitivities at a fixed level of specificity. Stat Med 2006; 25: 3487–3502.

13.

Shan

Hutson

. An efficient and exact approach for detecting trends with binary endpoints. Stat Med 2012; 31: 155–164.

14.

Shan

Hutson

. Some tests for detecting trends based on the modified Baumgartner-Weiß-Schindler statistics. Comput Stat Data Anal 2013; 57: 246–261.

15.

Shan

. Unconditional tests for comparing two ordered multinomials. Stat Methods Med Res 2012. Epub ahead of print 13 June 2012. DOI: 10.1177/0962280212450957.