Edward Kessler and colleagues used the Analytic Hierarchy Process to identify the best initial test in a potential test sequence (for a 52yo man entering ER with moderately severed upper abdominal pain and for whom the possible diagnoses were determined to be: gastritis, ulcer, cholecystitis and pancreatitis) They went on to suggest using it again, after the initial test result is known and disease probabilities revised accordingly, to identify the next optimal test. (N.B. An optimal test sequence is not identified in advance.) - Minimise cost
- Minimise discomfort
- Minimise risk
- Maximise diagnostic ability
- Abdominal CT (Computed Tomography)
- Upper GI series (GastroIntestinal)
- Abdominal ultrasound
- Endoscopy
Overall diagnostic abilities were calculated from sensitivities and specificities for each test for each of four candidate diseases, weighted by prior probability of these. Risk and Discomfort Ratings were judgements made by 5 physicians involved in study. Costs were from Hospital tariff. Ratings on each attribute are normalised (i.e. are in distributed mode) Weightings were supplied by the 5 physicians. Slide 1 in the gallery uses the Castro study weights, which identify an upper GI series as the best first option. Slide 2 shows how greater weight to diagnostic ability makes endoscopy optimal, while greater weight to discomfort brings Ultrasound to the fore Frank Castro, Leonard P Caccamo, Kimbroe J Carter, Barbara A Erickson, William Johnson, Edward Kessler, Nathan P Ritchey, Claudio A Ruiz (1996) Sequential test selection in the analysis of Adominal Pain Medical Decision Making 16: 178-183 The purpose of presenting an Annalisa version of a study conducted using another MCDA method (such as the Analytic Hierarchy Process) is to summarise and present the analysis in a simple and attractive one-screen format for a large audience - and to permit the interested viewer to download the .alt file and interact with the Weightings and Ratings to determine the effect of changes on the Scores. Alternatively the .alt file may be used as a 'starter' for a new analysis. No opinion is expressed or implied in regard to the merits of the study on any criterion.
download alt file here
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