Sequential Test Selection in the Analysis of Abdominal Pain

Abstract

Numerous decision-making tools exist to assist physicians in diagnosis management. However, the accuracy of available clinical information is often ambiguous or unknown and current analytical models do not explicitly incorporate judgementally defined information. A model encompassing both physician judgment and probability analysis was developed to accommodate such data. A problem requiring sequential diagnostic testing was structured utilizing the analytic hierarchy process (AHP). The case presented involved a patient complaining of upper abdominal pain who, after initial evaluation, did not need immediate surgery. Physicians were faced with identifying the optimal sequence of diagnostic testing. The criteria used for test selection included minimizing risk, patient discomfort, and cost of testing and maximizing diagnostic capability. Although at the onset the "best" test choice was unknown, the clinical picture indicated four test alternatives: upper gastrointestinal series (GI), abdominal ultrasonography (US), abdominal computed tomography (CT), and upper gastrointestinal endoscopy (END). Based upon the relative preferences of the criteria utilized, the AHP analysis indicated that upper GI series was the optimal first test. Given a negative test, posterior probabilities were calculated using Bayes' theorem, resulting in a new estimate of diagnostic capability. The AHP analysis was reiterated, identifying abdominal ultrasonography as the optimal second test. This analysis may be repeated as many times as necessary. Sensitivity analysis demonstrated that changing criteria preferences may alter the choice of tests and/or their sequence.

The analytic hierarchy process in medical and health care decision making: A literature review

“…The difference between patient and physician preferences related to the ranking of the criterion: identify the cause of bleeding. Castro et al (1996) applied the AHP to the sequential selection of diagnostic tests for the analysis of upper abdominal pain. The criteria considered were cost, discomfort, risk, and diagnostic ability, while the alternatives were abdominal CT, upper GI series, abdominal ultrasound, and endoscopy.…”

Sequential Test Selection by Quantifying of the Reduction in Diagnostic Uncertainty for the Diagnosis of Proximal Caries

“…These results are shown in Figures 3 and 4 about the presence or absence of disease is not clear when using only one test, multiple tests could be used to ensure an accurate diagnosis. Performing sequential diagnostic tests depends on minimising risk, patient discomfort, and the cost of testing whilst maximising diagnostic capability (8). Clinicians also need to use statistical tools for test selection in the determination of the optimum diagnostic test in each step.…”

An AHP Approach to Assess Hospital Websites

“…Dolan et al, [33] provided a detailed review of the theoretical foundations and methodology of the AHP using the treatment of a dog bite wound as motivating example. Castro et al, [34] applied AHP to the selection of diagnostic tests for upper abdominal pain. Richmen et al, [35] applied the AHP for prostate cancer treatment.…”