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Good Positive and Negative Likelihood Ratios

Good Positive Likelihood Ratio

Poorly Diagnostic Findings

Infective Endocarditis: Likelihood Ratios

Introduction: Endocarditis refers to bacterial infection of the heart valves, manifested by vegetations of bacteria growing on the valves. Endocarditis will cause bacteremia and septic emboli; it may also destroy the valve involved.

Nowadays, the Duke Criteria are the clinical 'gold standard' diagnostic test (though obviously, pathology is the true gold standard) - but note that the Duke criteria are certainly not completely sensitive and may be nonspecific, depending on the case series (see below). The two papers cited below disagree about whether 'possible' endocarditis by Duke criteria should be considered as truly positive or not.

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Tags: Cardiac Problem Infection Tag this Diagnosis.

Prevalence

Population / CalculatorPrevalence Comments / Study / Link
Patients given TTE with suspicion of endocarditis 4% Q J Med 2006; 99:23–31. PMID 16330508
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The likelihood ratios of findings for Infective Endocarditis are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %. Post-Test Probability (Predictive Value): %. Switch to display mode.
**Note that calculating probabilities from more than one finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)
Good Positive and Negative Likelihood Ratios
FindingResult +LR-LR
[ + ] Duke Criteria + 0 - 8.30
[ + ] Trans-Esophageal Echocardiography + 0 - inf0.1
[ + ] Duke Criteria + 0 - 25.30.2
[ + ] Blood Cultures + 0 - 2.60.3
[ + ] Von Reyn Criteria + 0 - 8.60.3
Good Positive Likelihood Ratio
FindingResult +LR-LR
[ + ] Trans-Thoracic Echocardiography + 0 - 220.6
Poorly Diagnostic Findings
FindingResult +LR-LR
[ + ] Osler's Nodes Sensitivity = 10%
[ + ] Janeway Lesion Sensitivity = 10%