A Priori Determination of the Pretest Probability

Abstract

In this manuscript, we present various proposed methods estimate the prevalence of disease, a critical prerequisite for the adequate interpretation of screening tests. To address the limitations of these approaches, which revolve primarily around their a posteriori nature, we introduce a novel method to estimate the pretest probability of disease, a priori, utilizing the Logit function from the logistic regression model. This approach is a modification of McGee's heuristic, originally designed for estimating the posttest probability of disease. In a patient presenting with $n_\theta$ signs or symptoms, the minimal bound of the pretest probability, $\phi$, can be approximated by: $\phi \approx \frac{1}{5}{ln\left[\displaystyle\prod_{\theta=1}^{i}\kappa_\theta\right]}$ where $ln$ is the natural logarithm, and $\kappa_\theta$ is the likelihood ratio associated with the sign or symptom in question.