This review outlines the definitions of diagnostic test performance metrics such as sensitivity, specificity, and diagnostic yield in the context of investigating syncope.
Clarifies diagnostic metrics for syncope evaluation; leaves open their validation in prospective algorithms.
Following a thorough history, physical examination, and electrocardiography, the cause of syncope remains undiagnosed in around 50% of patients.1 Diagnostic investigations are performed to confirm a suspected diagnosis or to explore another potential cause. When exploring the cause of syncope, features of the initial history and examination should direct the investigations wherever possible. The usefulness of a test can be described in various terms. The sensitivity of a test measures how effective it is in detecting those individuals who are truly diseased (true positives). The specificity of a test measures how effective it is in detecting those individuals who are not diseased (true negatives). The positive predictive value of a test is the probability of actually having a condition given that the test result is positive. The negative predictive value is the probability of not having the disease given that the test is negative. The diagnostic yield of a test is defined by the percentage of patients who receive a diagnosis or have a diagnosis confidently dismissed as a consequence of the test. That is the sum of the number of true positives and, if available, true negatives as a proportion of the total number of tests performed.
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Arthur et al. (2001) studied this question.
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