Paperchase1 - Decision Rule SAH

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David C. -

My problem with most of the decision rules that come out of Canada is if a patient meets all of the requirements for no further testing indicated, you wouldn't have been worried or thinking about the disease or process in the first place.

Mathias T. -

The contributors seem to be confused with sensitivity vs specificity. At the 11:25 mark, they complain about the rules being not 'specific' enough to 'rule out' the disease. That's just plain wrong. Specific tests can rule in, and sensitive tests can rule out diagnosis. That's probalby a slip of tongue, but then they go on about the poor specificity of the rules, which shows that they are really confused on how to interpret the characteristics of those rules.

Guys, the rules are designed to be extra sensitive, so if they are negative you can rule out SAH. Nobody cares about specificity, because they are not designed to make a diagnosis, just to rule it out. Of course a test designed to be 100% sensitive will have a very poor specificity, but you just don't care.... That's certainly not 'a big problem' as stated in this podcast, it's actually a non-issue.

Difficult to take the rest of the comments seriously when such basic epidemiology facts are not mastered...

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