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Tim Duffy's avatar

Sean,

I’m looking forward to hearing about Baysean reasoning and started writing a question to you on this topic. However, since I wrote it down I’ve since come up with the solution myself. I’m curious if my understanding is in concert with yours and I figure it might be useful for the rest of the fellows (or in our current cohort, fellas). Here it is:

I understand the importance of base rate, but I’ve been bothered when applying Baysean reasoning when the disease/injury prevalence data has a large range of reported incidence. My observation is that this is a problem in conditions with poorer diagnostic agreement and often reserved for syndromes. There tends to be a lot of these in musculoskeletal injuries. A good example is SIJ pain where the estimated incidence is troublingly variable. For an example, the estimate of SIJ pain is said to be between 15-30% of the population (Cohen, 2005).

My solution to this was to use a Fagan’s nomogram, assign a made-up special test with a value of +7 LR and plug it in using a pre-test probability of 15 and 30. I then cheated and plugged in this to ChatGPT to get the exact numbers…

“let's say I have a special test with a positive likelihood ratio (+LR) of 7 that I use on two diseases. Disease A has a prevalence of 15% of the population and disease B has a prevalence of 30% of the population. Could you calculate the post-test probabilities for each of these scenarios?”

Chat GPT did the math for me (and showed the work) providing a final answer of:

Disease A (Prevalence 15%) → Post-test probability: 55.2%

Disease B (Prevalence 30%) → Post-test probability: 75%

So how should I use this data? Take an average? Use 15? Use 30? Continue to question the existence of SIJ pain?

This leant me to ask a more philosophical question of does the base rate that is published (empirical domain) reflect the actual and real domains.

Thanks!

Tim

Cohen SP. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis, and treatment. Anesth Analg. 2005;101(5):1440-1453

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Tim Duffy's avatar

Hi Sean,

I just used Models4PT using the exact same instructions provided by the video. Super easy to use!

Thanks!

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