Enhanced Youden's index with net benefit: A feasible approach for optimal‐threshold determination in shared decision making

Abstract

Objectives To establish an enhanced Youden's index with net benefit, as a scientific method for optimal‐threshold determination in shared decision making. Method We redefined the Youden's index by changing the target function from the maximization of accuracy to the maximization of net benefit and established the process for pursuing the patient's individual optimal‐threshold. In addition, we illustrated how the enhanced Youden's index works with an example of cataract operation decision making using the data from Shanghai, China. Results We modified the method of calculating net benefit in decision curve analysis and fused it with Youden's index to expand the purpose from finding a threshold with the best test accuracy to finding one with the best net benefit. As an example, we used the enhanced Youden's index to establish an optimal‐thresholds list for cataract operation decision making. Then, we calculated three imaginary patients’ respective thresholds after integrating the local recovery rate, their visual activities, and individual preferences. The results demonstrated that the thresholds of patients with the same objective examination results might vary widely due to their individual preferences. Therefore, the thresholds are more individualized according to the enhanced Youden's index. Conclusion The enhanced Youden's index can establish the optimal‐thresholds from the perspective of maximization of patients' net benefit and provide a quantifiable method for shared decision making.

Performance of CURB-65 and ISARIC 4C mortality scores for hospitalized patients with confirmed COVID-19 infection in Saudi Arabia

“…To compare the ISARIC 4C mortality score and the CURB-65 score, the ISARIC-4C score was standardized into three risk groups (low [0–3], medium [ [4] , [5] , [6] , [7] , [8] ], and high [ 9 , 21 ]) to avoid a different number of risk groups between both scores according to the guidelines [ 18 , 19 ]. The diagnostic accuracy of both scores was evaluated by calculating sensitivities, specificities, positive predictive value, negative predictive value, and Youden's J indices (YJI) [ 24 ]. In addition, a receiver operating characteristic (ROC) analysis and an area under the curve (AUC) calculation were performed to ascertain the precision of discrimination of the estimated scores.…”

The Predictive Validity of Functional Outcome Measures With Discharge Destination for Hospitalized Medical Patients

“…The calculated cut points of the Youden index are the values that provide the best trade-off between sensitivity and specificity. 29 , 30 , 31 Subsequently, logistic regression models were fit to test for association between dichotomized measures (6-Clicks Basic Mobility, 6-Clicks Daily Activity, HFML, and JH-HLM) and chances of going home, adjusted for age, and sex. For each outcome measure, ROC curves were plotted and cut points were optimized using the Youden Index 2 in order to identify the most effective score for our purpose of predicting discharge destination of home.…”

“…For each outcome measure, ROC curves were plotted and cut points were optimized using the Youden Index 2 in order to identify the most effective score for our purpose of predicting discharge destination of home. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 The Youden's J index combines sensitivity and specificity into a single measure (Sensitivity + Specificity - 1) and has a value between 0 and 1. For our statistical analyses, we used SAS software (SAS Institute, Inc, Cary, NC).…”

Editorial introduction: Decision making, reasoning, context, and perspective

“…[18][19][20] The edition concludes with a number of papers proposing innovative methods for implementing and evaluating the impact of PCC and SDM. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Again, the core concepts of PCC and SDM are explored across a very diverse set of contexts. It would of course be misleading to present this edition as the "conclusion" of the debate commenced in our previous thematic issue on this subject.…”

“…The edition concludes with a number of papers proposing innovative methods for implementing and evaluating the impact of PCC and SDM . Again, the core concepts of PCC and SDM are explored across a very diverse set of contexts.…”