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Likelihood ratios in diagnostic testing - Wikipedia
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<div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Likelihood ratios used for assessing the value of performing a diagnostic test</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">This article is about the use of likelihood ratios in interpreting diagnostic tests. For a general description of the likelihood ratio, see <a href="/wiki/Likelihood_ratio" class="mw-redirect" title="Likelihood ratio">Likelihood ratio</a>. For the statistical test to compare goodness of fit, see <a href="/wiki/Likelihood-ratio_test" title="Likelihood-ratio test">Likelihood-ratio test</a>.</div> <p class="mw-empty-elt"> </p><p>In <a href="/wiki/Evidence-based_medicine" title="Evidence-based medicine">evidence-based medicine</a>, <a href="/wiki/Likelihood_ratio" class="mw-redirect" title="Likelihood ratio">likelihood ratios</a> are used for assessing the value of performing a <a href="/wiki/Diagnostic_test" class="mw-redirect" title="Diagnostic test">diagnostic test</a>. They use the <a href="/wiki/Sensitivity_and_specificity" title="Sensitivity and specificity">sensitivity and specificity</a> of the test to determine whether a test result usefully changes the probability that a condition (such as a disease state) exists. The first description of the use of likelihood ratios for <a href="/wiki/Decision_rule" title="Decision rule">decision rules</a> was made at a symposium on information theory in 1954.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> In medicine, likelihood ratios were introduced between 1975 and 1980.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Calculation">Calculation</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Likelihood_ratios_in_diagnostic_testing&action=edit&section=1" title="Edit section: Calculation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Two versions of the likelihood ratio exist, one for positive and one for negative test results. Respectively, they are known as the <b><style data-mw-deduplicate="TemplateStyles:r1238216509">.mw-parser-output .vanchor>:target~.vanchor-text{background-color:#b1d2ff}@media screen{html.skin-theme-clientpref-night .mw-parser-output .vanchor>:target~.vanchor-text{background-color:#0f4dc9}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .vanchor>:target~.vanchor-text{background-color:#0f4dc9}}</style><span class="vanchor"><span id="positive_likelihood_ratio"></span><span class="vanchor-text">positive likelihood ratio</span></span></b> (LR+, <b>likelihood ratio positive</b>, <b>likelihood ratio for positive results</b>) and <b><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238216509"><span class="vanchor"><span id="negative_likelihood_ratio"></span><span class="vanchor-text">negative likelihood ratio</span></span></b> (LR–, <b>likelihood ratio negative</b>, <b>likelihood ratio for negative results</b>). </p><p>The positive likelihood ratio is calculated as </p> <dl><dd><span class="mwe-math-element"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle {\text{LR}}+={\frac {\text{sensitivity}}{1-{\text{specificity}}}}}"> <semantics> <mrow class="MJX-TeXAtom-ORD"> <mstyle displaystyle="true" scriptlevel="0"> <mrow class="MJX-TeXAtom-ORD"> <mtext>LR</mtext> </mrow> <mo>+</mo> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mfrac> <mtext>sensitivity</mtext> <mrow> <mn>1</mn> <mo>−<!-- − --></mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>specificity</mtext> </mrow> </mrow> </mfrac> </mrow> </mstyle> </mrow> <annotation encoding="application/x-tex">{\displaystyle {\text{LR}}+={\frac {\text{sensitivity}}{1-{\text{specificity}}}}}</annotation> </semantics> </math></span><img src="https://wikimedia.org/api/rest_v1/media/math/render/svg/69c271a38eb15624ca251b406604f145bf3a5ebc" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -2.338ex; width:22.999ex; height:5.843ex;" alt="{\displaystyle {\text{LR}}+={\frac {\text{sensitivity}}{1-{\text{specificity}}}}}"></span></dd></dl> <p>which is equivalent to </p> <dl><dd><span class="mwe-math-element"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle {\text{LR}}+={\frac {\Pr({T+}\mid D+)}{\Pr({T+}\mid D-)}}}"> <semantics> <mrow class="MJX-TeXAtom-ORD"> <mstyle displaystyle="true" scriptlevel="0"> <mrow class="MJX-TeXAtom-ORD"> <mtext>LR</mtext> </mrow> <mo>+</mo> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mfrac> <mrow> <mo movablelimits="true" form="prefix">Pr</mo> <mo stretchy="false">(</mo> <mrow class="MJX-TeXAtom-ORD"> <mi>T</mi> <mo>+</mo> </mrow> <mo>∣<!-- ∣ --></mo> <mi>D</mi> <mo>+</mo> <mo stretchy="false">)</mo> </mrow> <mrow> <mo movablelimits="true" form="prefix">Pr</mo> <mo stretchy="false">(</mo> <mrow class="MJX-TeXAtom-ORD"> <mi>T</mi> <mo>+</mo> </mrow> <mo>∣<!-- ∣ --></mo> <mi>D</mi> <mo>−<!-- − --></mo> <mo stretchy="false">)</mo> </mrow> </mfrac> </mrow> </mstyle> </mrow> <annotation encoding="application/x-tex">{\displaystyle {\text{LR}}+={\frac {\Pr({T+}\mid D+)}{\Pr({T+}\mid D-)}}}</annotation> </semantics> </math></span><img src="https://wikimedia.org/api/rest_v1/media/math/render/svg/e03b654913206f562b5953357f6bff991c2150fa" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -2.671ex; width:22.324ex; height:6.509ex;" alt="{\displaystyle {\text{LR}}+={\frac {\Pr({T+}\mid D+)}{\Pr({T+}\mid D-)}}}"></span></dd></dl> <p>or "the probability of a person who <b>has the disease</b> testing positive divided by the probability of a person who <b>does not have the disease</b> testing positive." Here "<i>T</i>+" or "<i>T</i>−" denote that the result of the test is positive or negative, respectively. Likewise, "<i>D</i>+" or "<i>D</i>−" denote that the disease is present or absent, respectively. So "true positives" are those that test positive (<i>T</i>+) and have the disease (<i>D</i>+), and "false positives" are those that test positive (<i>T</i>+) but do not have the disease (<i>D</i>−). </p><p>The negative likelihood ratio is calculated as<sup id="cite_ref-altman_5-0" class="reference"><a href="#cite_note-altman-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <dl><dd><span class="mwe-math-element"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle {\text{LR}}-={\frac {1-{\text{sensitivity}}}{\text{specificity}}}}"> <semantics> <mrow class="MJX-TeXAtom-ORD"> <mstyle displaystyle="true" scriptlevel="0"> <mrow class="MJX-TeXAtom-ORD"> <mtext>LR</mtext> </mrow> <mo>−<!-- − --></mo> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mfrac> <mrow> <mn>1</mn> <mo>−<!-- − --></mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>sensitivity</mtext> </mrow> </mrow> <mtext>specificity</mtext> </mfrac> </mrow> </mstyle> </mrow> <annotation encoding="application/x-tex">{\displaystyle {\text{LR}}-={\frac {1-{\text{sensitivity}}}{\text{specificity}}}}</annotation> </semantics> </math></span><img src="https://wikimedia.org/api/rest_v1/media/math/render/svg/ff90c7529f91a0dd772a32c84f1948edb5ab372f" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -2.338ex; width:23.271ex; height:5.843ex;" alt="{\displaystyle {\text{LR}}-={\frac {1-{\text{sensitivity}}}{\text{specificity}}}}"></span></dd></dl> <p>which is equivalent to<sup id="cite_ref-altman_5-1" class="reference"><a href="#cite_note-altman-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <dl><dd><span class="mwe-math-element"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle {\text{LR}}-={\frac {\Pr({T-}\mid D+)}{\Pr({T-}\mid D-)}}}"> <semantics> <mrow class="MJX-TeXAtom-ORD"> <mstyle displaystyle="true" scriptlevel="0"> <mrow class="MJX-TeXAtom-ORD"> <mtext>LR</mtext> </mrow> <mo>−<!-- − --></mo> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mfrac> <mrow> <mo movablelimits="true" form="prefix">Pr</mo> <mo stretchy="false">(</mo> <mrow class="MJX-TeXAtom-ORD"> <mi>T</mi> <mo>−<!-- − --></mo> </mrow> <mo>∣<!-- ∣ --></mo> <mi>D</mi> <mo>+</mo> <mo stretchy="false">)</mo> </mrow> <mrow> <mo movablelimits="true" form="prefix">Pr</mo> <mo stretchy="false">(</mo> <mrow class="MJX-TeXAtom-ORD"> <mi>T</mi> <mo>−<!-- − --></mo> </mrow> <mo>∣<!-- ∣ --></mo> <mi>D</mi> <mo>−<!-- − --></mo> <mo stretchy="false">)</mo> </mrow> </mfrac> </mrow> </mstyle> </mrow> <annotation encoding="application/x-tex">{\displaystyle {\text{LR}}-={\frac {\Pr({T-}\mid D+)}{\Pr({T-}\mid D-)}}}</annotation> </semantics> </math></span><img src="https://wikimedia.org/api/rest_v1/media/math/render/svg/74f24be61ed47a89e94d1348d47584eaefa96c6a" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -2.671ex; width:22.324ex; height:6.509ex;" alt="{\displaystyle {\text{LR}}-={\frac {\Pr({T-}\mid D+)}{\Pr({T-}\mid D-)}}}"></span></dd></dl> <p>or "the probability of a person who <b>has the disease</b> testing negative divided by the probability of a person who <b>does not have the disease</b> testing negative." </p><p>The calculation of likelihood ratios for tests with continuous values or more than two outcomes is similar to the calculation for <a href="/wiki/Dichotomous_variable" class="mw-redirect" title="Dichotomous variable">dichotomous</a> outcomes; a separate likelihood ratio is simply calculated for every level of test result and is called interval or stratum specific likelihood ratios.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>The <a href="/wiki/Pre-_and_post-test_probability#Pre-test_probability" title="Pre- and post-test probability">pretest odds</a> of a particular diagnosis, multiplied by the likelihood ratio, determines the <a href="/wiki/Pre-_and_post-test_probability" title="Pre- and post-test probability">post-test odds</a>. This calculation is based on <a href="/wiki/Bayes%27_theorem" title="Bayes' theorem">Bayes' theorem</a>. (Note that odds can be calculated from, and then converted to, <a href="/wiki/Probability" title="Probability">probability</a>.) </p> <div class="mw-heading mw-heading2"><h2 id="Application_to_medicine">Application to medicine</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Likelihood_ratios_in_diagnostic_testing&action=edit&section=2" title="Edit section: Application to medicine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Pretest probability refers to the chance that an individual in a given population has a disorder or condition; this is the baseline probability prior to the use of a diagnostic test. Post-test probability refers to the probability that a condition is truly present given a positive test result. For a good test in a population, the post-test probability will be meaningfully higher or lower than the pretest probability. A high likelihood ratio indicates a good test for a population, and a likelihood ratio close to one indicates that a test may not be appropriate for a population. </p><p>For a <a href="/wiki/Screening_test" class="mw-redirect" title="Screening test">screening test</a>, the population of interest might be the general population of an area. For diagnostic testing, the ordering clinician will have observed some symptom or other factor that raises the pretest probability relative to the general population. A likelihood ratio of greater than 1 for a test in a population indicates that a positive test result is evidence that a condition is present. If the likelihood ratio for a test in a population is not clearly better than one, the test will not provide good evidence: the post-test probability will not be meaningfully different from the pretest probability. Knowing or estimating the likelihood ratio for a test in a population allows a clinician to better interpret the result.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Research suggests that physicians rarely make these calculations in practice, however,<sup id="cite_ref-pmid9576412_8-0" class="reference"><a href="#cite_note-pmid9576412-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> and when they do, they often make errors.<sup id="cite_ref-pmid11934776_9-0" class="reference"><a href="#cite_note-pmid11934776-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> A <a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">randomized controlled trial</a> compared how well physicians interpreted diagnostic tests that were presented as either <a href="/wiki/Sensitivity_(tests)" class="mw-redirect" title="Sensitivity (tests)">sensitivity</a> and <a href="/wiki/Specificity_(tests)" class="mw-redirect" title="Specificity (tests)">specificity</a>, a likelihood ratio, or an inexact graphic of the likelihood ratio, found no difference between the three modes in interpretation of test results.<sup id="cite_ref-pmid16061916_10-0" class="reference"><a href="#cite_note-pmid16061916-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Estimation_table">Estimation table</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Likelihood_ratios_in_diagnostic_testing&action=edit&section=3" title="Edit section: Estimation table"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>This table provide examples of how changes in the likelihood ratio affects post-test probability of disease. </p> <table class="wikitable"> <tbody><tr> <th>Likelihood ratio </th> <th>Approximate* change <p>in probability<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p> </th> <th>Effect on posttest <p>Probability of disease<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> </th></tr> <tr> <th>Values between 0 and 1 <i>decrease</i> the probability of disease <span class="nowrap">(−LR)</span> </th> <td> </td> <td> </td></tr> <tr> <td>0.1 </td> <td>−45% </td> <td>Large decrease </td></tr> <tr> <td>0.2 </td> <td>−30% </td> <td>Moderate decrease </td></tr> <tr> <td>0.5 </td> <td>−15% </td> <td>Slight decrease </td></tr> <tr> <td>1 </td> <td>−0% </td> <td>None </td></tr> <tr> <th>Values greater than 1 <i>increase</i> the probability of disease <span class="nowrap">(+LR)</span> </th> <td> </td> <td> </td></tr> <tr> <td>1 </td> <td>+0% </td> <td>None </td></tr> <tr> <td>2 </td> <td>+15% </td> <td>Slight increase </td></tr> <tr> <td>5 </td> <td>+30% </td> <td>Moderate increase </td></tr> <tr> <td>10 </td> <td>+45% </td> <td>Large increase </td></tr></tbody></table> <p>*These estimates are accurate to within 10% of the calculated answer for all pre-test probabilities between 10% and 90%. The average error is only 4%. For polar extremes of pre-test probability >90% and <10%, see <a href="#Estimation_of_pre-_and_post-test_probability">Estimation of pre- and post-test probability</a> section below. </p> <div class="mw-heading mw-heading3"><h3 id="Estimation_example">Estimation example</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Likelihood_ratios_in_diagnostic_testing&action=edit&section=4" title="Edit section: Estimation example"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ol><li>Pre-test probability: For example, if about 2 out of every 5 patients with <a href="/wiki/Abdominal_distension" title="Abdominal distension">abdominal distension</a> have <a href="/wiki/Ascites" title="Ascites">ascites</a>, then the pretest probability is 40%.</li> <li>Likelihood Ratio: An example "test" is that the physical exam finding of bulging <a href="/wiki/Flank_(anatomy)" title="Flank (anatomy)">flanks</a> has a positive likelihood ratio of 2.0 for ascites.</li> <li>Estimated change in probability: Based on table above, a likelihood ratio of 2.0 corresponds to an approximately +15% increase in probability.</li> <li>Final (post-test) probability: Therefore, bulging flanks increases the probability of ascites from 40% to about 55% (i.e., 40% + 15% = 55%, which is within 2% of the exact probability of 57%).</li></ol> <div class="mw-heading mw-heading2"><h2 id="Calculation_example">Calculation example</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Likelihood_ratios_in_diagnostic_testing&action=edit&section=5" title="Edit section: Calculation example"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A medical example is the likelihood that a given test result would be expected in a patient with a certain disorder compared to the likelihood that same result would occur in a patient without the target disorder. </p><p>Some sources distinguish between LR+ and LR−.<sup id="cite_ref-urlLikelihood_ratios_13-0" class="reference"><a href="#cite_note-urlLikelihood_ratios-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> A worked example is shown below. </p> <div style="float:right;"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl dl,.mw-parser-output .hlist dl ol,.mw-parser-output .hlist dl ul,.mw-parser-output .hlist ol dl,.mw-parser-output .hlist ol ol,.mw-parser-output .hlist ol ul,.mw-parser-output .hlist ul dl,.mw-parser-output .hlist ul ol,.mw-parser-output .hlist ul ul{display:inline}.mw-parser-output .hlist .mw-empty-li{display:none}.mw-parser-output .hlist dt::after{content:": "}.mw-parser-output .hlist dd::after,.mw-parser-output .hlist li::after{content:" · ";font-weight:bold}.mw-parser-output .hlist dd:last-child::after,.mw-parser-output .hlist dt:last-child::after,.mw-parser-output .hlist li:last-child::after{content:none}.mw-parser-output .hlist dd dd:first-child::before,.mw-parser-output .hlist dd dt:first-child::before,.mw-parser-output .hlist dd li:first-child::before,.mw-parser-output .hlist dt dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist"><ul><li class="nv-view"><a href="/wiki/Template:SensSpecPPVNPV" title="Template:SensSpecPPVNPV"><span title="View this template">view</span></a></li><li class="nv-talk"><a href="/wiki/Template_talk:SensSpecPPVNPV" title="Template talk:SensSpecPPVNPV"><span title="Discuss this template">talk</span></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:SensSpecPPVNPV" title="Special:EditPage/Template:SensSpecPPVNPV"><span title="Edit this template">edit</span></a></li></ul></div></div> <dl><dt>A worked example</dt> <dd>A diagnostic test with sensitivity 67% and specificity 91% is applied to 2030 people to look for a disorder with a population prevalence of 1.48%</dd></dl> <table class="wikitable" style="text-align:center; border:none; background:transparent;"> <tbody><tr> <td colspan="2" style="border:none;"> </td> <td colspan="2" style="background:#bbeeee;"><b><a href="/wiki/Fecal_occult_blood" title="Fecal occult blood">Fecal occult blood</a> screen test outcome</b> </td> <td colspan="2" style="border:none;text-align:right;"><sup><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist"><ul><li class="nv-view"><a href="/wiki/Template:Diagnostic_testing_example" title="Template:Diagnostic testing example"><span title="View this template">view</span></a></li><li class="nv-talk"><a href="/w/index.php?title=Template_talk:Diagnostic_testing_example&action=edit&redlink=1" class="new" title="Template talk:Diagnostic testing example (page does not exist)"><span title="Discuss this template">talk</span></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Diagnostic_testing_example" title="Special:EditPage/Template:Diagnostic testing example"><span title="Edit this template">edit</span></a></li></ul></div></sup> </td></tr> <tr> <td style="border:none;"> </td> <td style="background:#eeeeee;"><a href="/wiki/Statistical_population" title="Statistical population">Total population</a><br />(pop.) = 2030 </td> <td style="background:#ccffff;">Test outcome <b>positive</b> </td> <td style="background:#aadddd;">Test outcome <b>negative</b> </td> <td style="border-left:double silver;border-bottom:double silver;"><a href="/wiki/Accuracy_and_precision" title="Accuracy and precision">Accuracy</a> (ACC) <div style="margin-left:1em; white-space:nowrap; text-align:left;">= (TP + TN) / pop.<br />= (20 + 1820) / 2030<br />≈ <b>90.64%</b></div> </td> <td style="border-left:double silver;border-bottom:double silver;line-height:2;"><a href="/wiki/F1_score" class="mw-redirect" title="F1 score">F<sub>1</sub> score</a> <div style="margin-left:1em; white-space:nowrap; text-align:left; font-size:118%;">= 2 × <style data-mw-deduplicate="TemplateStyles:r1214402035">.mw-parser-output .sfrac{white-space:nowrap}.mw-parser-output .sfrac.tion,.mw-parser-output .sfrac .tion{display:inline-block;vertical-align:-0.5em;font-size:85%;text-align:center}.mw-parser-output .sfrac .num{display:block;line-height:1em;margin:0.0em 0.1em;border-bottom:1px solid}.mw-parser-output .sfrac .den{display:block;line-height:1em;margin:0.1em 0.1em}.mw-parser-output .sr-only{border:0;clip:rect(0,0,0,0);clip-path:polygon(0px 0px,0px 0px,0px 0px);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px}</style><span class="sfrac">⁠<span class="tion"><span class="num">precision × recall</span><span class="sr-only">/</span><span class="den">precision + recall</span></span>⁠</span><br />≈ <b>0.174</b></div> </td></tr> <tr> <td rowspan="2" style="background:#eeeebb;"><b>Patients with<br /><a href="/wiki/Bowel_cancer" class="mw-redirect" title="Bowel cancer">bowel cancer</a><br />(as confirmed<br />on <a href="/wiki/Endoscopy" title="Endoscopy">endoscopy</a>)</b> </td> <td style="background:#ffffcc;">Actual condition<br />positive (AP)<br />= 30<br />(2030 × 1.48%) </td> <td style="background:#ccffcc;"><span style="color:#006600;"><b>True positive</b> (TP)</span><br />= 20<br />(2030 × 1.48% × 67%) </td> <td style="background:#ffdddd;"><span style="color:#cc0000;"><b>False negative</b> (FN)</span><br />= 10<br />(2030 × 1.48% × <span class="nowrap">(100% − 67%)</span>) </td> <td style="background:#eeffee;"><a href="/wiki/True_positive_rate" class="mw-redirect" title="True positive rate">True positive rate</a> (TPR), <a href="/wiki/Recall_(information_retrieval)" class="mw-redirect" title="Recall (information retrieval)">recall</a>, <a href="/wiki/Sensitivity_and_specificity" title="Sensitivity and specificity">sensitivity</a><div style="margin-left:1em; white-space:nowrap; text-align:left;">= TP / AP<br />= 20 / 30<br />≈ <b>66.7%</b></div> </td> <td style="background:#ffeeee;"><a href="/wiki/False_negative_rate" class="mw-redirect" title="False negative rate">False negative rate</a> (FNR), miss rate<br /> <div style="margin-left:1em; white-space:nowrap; text-align:left;">= FN / AP<br />= 10 / 30<br /> ≈ <b>33.3%</b></div> </td></tr> <tr> <td style="background:#ddddaa;">Actual condition<br />negative (AN)<br />= 2000<br />(2030 × <span class="nowrap">(100% − 1.48%)</span>) </td> <td style="background:#ffcccc;"><span style="color:#cc0000;"><b>False positive</b> (FP)</span><br />= 180<br />(2030 × <span class="nowrap">(100% − 1.48%)</span> × <span class="nowrap">(100% − 91%)</span>) </td> <td style="background:#bbeebb;"><span style="color:#006600;"><b>True negative</b> (TN)</span><br />= 1820<br />(2030 × <span class="nowrap">(100% − 1.48%)</span> × 91%) </td> <td style="background:#eedddd;"><a href="/wiki/False_positive_rate" title="False positive rate">False positive rate</a> (FPR), <a href="/wiki/Information_retrieval" title="Information retrieval"><span class="nowrap">fall-out</span></a>, <span class="nowrap">probability of false alarm</span> <div style="margin-left:1em; white-space:nowrap; text-align:left;">= FP / AN<br />= 180 / 2000<br />= <b>9.0%</b></div> </td> <td style="background:#ddeedd;"><a href="/wiki/Sensitivity_and_specificity" title="Sensitivity and specificity">Specificity</a>, selectivity, <a href="/wiki/True_negative_rate" class="mw-redirect" title="True negative rate">true negative rate</a> (TNR)<div style="margin-left:1em; white-space:nowrap; text-align:left;">= TN / AN<br />= 1820 / 2000<br />= <b>91%</b></div> </td></tr> <tr> <td rowspan="2" style="border:none;"> </td> <td style="border-right:double silver;"><a href="/wiki/Prevalence" title="Prevalence">Prevalence</a><div style="margin-left:1em; white-space:nowrap; text-align:left;">= AP / pop.<br />= 30 / 2030<br />≈ <b>1.48%</b></div> </td> <td style="background:#eeffee;"><a href="/wiki/Positive_predictive_value" class="mw-redirect" title="Positive predictive value">Positive predictive value</a> (PPV), <a href="/wiki/Precision_(information_retrieval)" class="mw-redirect" title="Precision (information retrieval)">precision</a><div style="margin-left:1em; white-space:nowrap; text-align:left;">= TP / (TP + FP)<br />= 20 / (20 + 180)<br />= <b>10%</b></div> </td> <td style="background:#ffeeee;"><a href="/wiki/False_omission_rate" class="mw-redirect" title="False omission rate">False omission rate</a> (FOR)<div style="margin-left:1em; white-space:nowrap; text-align:left;">= FN / (FN + TN)<br />= 10 / (10 + 1820)<br />≈ <b>0.55%</b></div> </td> <td style="background:#eeeeff;border-left:double silver;"><a href="/wiki/Positive_likelihood_ratio" class="mw-redirect" title="Positive likelihood ratio">Positive likelihood ratio</a> <span class="nowrap">(LR+)</span> <div style="margin-left:1em; white-space:nowrap; text-align:left;">= <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">TPR</span><span class="sr-only">/</span><span class="den">FPR</span></span>⁠</span><br />= (20 / 30) / (180 / 2000)<br />≈ <b>7.41</b></div> </td> <td style="background:#eeeeff;"><a href="/wiki/Negative_likelihood_ratio" class="mw-redirect" title="Negative likelihood ratio">Negative likelihood ratio</a> <span class="nowrap">(LR−)</span> <div style="margin-left:1em; white-space:nowrap; text-align:left;">= <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">FNR</span><span class="sr-only">/</span><span class="den">TNR</span></span>⁠</span><br />= (10 / 30) / (1820 / 2000)<br />≈ <b>0.366</b> </div> </td></tr> <tr> <td style="border:none;"> </td> <td style="background:#eedddd;"><a href="/wiki/False_discovery_rate" title="False discovery rate">False discovery rate</a> (FDR)<div style="margin-left:1em; white-space:nowrap; text-align:left;">= FP / (TP + FP)<br />= 180 / (20 + 180)<br />= <b>90.0%</b></div> </td> <td style="background:#ddeedd;"><a href="/wiki/Negative_predictive_value" class="mw-redirect" title="Negative predictive value">Negative predictive value</a> (NPV)<div style="margin-left:1em; white-space:nowrap; text-align:left;">= TN / (FN + TN)<br />= 1820 / (10 + 1820)<br />≈ <b>99.45%</b></div> </td> <td style="background:#eeeeff;border-left:double silver;" colspan="2"><a href="/wiki/Diagnostic_odds_ratio" title="Diagnostic odds ratio">Diagnostic odds ratio</a> (DOR) <div style="display:table; margin:0 auto; white-space:nowrap; text-align:left; font-size:118%;">= <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">LR+</span><span class="sr-only">/</span><span class="den">LR−</span></span>⁠</span><br />≈ <b>20.2</b></div> </td></tr></tbody></table> <p><b>Related calculations</b> </p> <ul><li>False positive rate (α) = <a href="/wiki/Type_I_and_type_II_errors#Type_I_error" title="Type I and type II errors">type I error</a> = 1 − specificity = FP / (FP + TN) = 180 / (180 + 1820) = 9%</li> <li>False negative rate (β) = <a href="/wiki/Type_I_and_type_II_errors#Type_II_error" title="Type I and type II errors">type II error</a> = 1 − sensitivity = FN / (TP + FN) = 10 / (20 + 10) ≈ 33%</li> <li><a href="/wiki/Statistical_power" class="mw-redirect" title="Statistical power">Power</a> = sensitivity = 1 − β</li> <li>Positive <a class="mw-selflink selflink">likelihood ratio</a> = sensitivity / (1 − specificity) ≈ 0.67 / (1 − 0.91) ≈ 7.4</li> <li>Negative likelihood ratio = (1 − sensitivity) / specificity ≈ (1 − 0.67) / 0.91 ≈ 0.37</li> <li><a href="/wiki/Prevalence_threshold" class="mw-redirect" title="Prevalence threshold">Prevalence threshold</a> = <span class="mwe-math-element"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle PT={\frac {{\sqrt {TPR(-TNR+1)}}+TNR-1}{(TPR+TNR-1)}}}"> <semantics> <mrow class="MJX-TeXAtom-ORD"> <mstyle displaystyle="true" scriptlevel="0"> <mi>P</mi> <mi>T</mi> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mfrac> <mrow> <mrow class="MJX-TeXAtom-ORD"> <msqrt> <mi>T</mi> <mi>P</mi> <mi>R</mi> <mo stretchy="false">(</mo> <mo>−<!-- − --></mo> <mi>T</mi> <mi>N</mi> <mi>R</mi> <mo>+</mo> <mn>1</mn> <mo stretchy="false">)</mo> </msqrt> </mrow> <mo>+</mo> <mi>T</mi> <mi>N</mi> <mi>R</mi> <mo>−<!-- − --></mo> <mn>1</mn> </mrow> <mrow> <mo stretchy="false">(</mo> <mi>T</mi> <mi>P</mi> <mi>R</mi> <mo>+</mo> <mi>T</mi> <mi>N</mi> <mi>R</mi> <mo>−<!-- − --></mo> <mn>1</mn> <mo stretchy="false">)</mo> </mrow> </mfrac> </mrow> </mstyle> </mrow> <annotation encoding="application/x-tex">{\displaystyle PT={\frac {{\sqrt {TPR(-TNR+1)}}+TNR-1}{(TPR+TNR-1)}}}</annotation> </semantics> </math></span><img src="https://wikimedia.org/api/rest_v1/media/math/render/svg/a72ddd1d947f475519099bcd33807bb501513d3f" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -2.671ex; width:40.177ex; height:7.009ex;" alt="{\displaystyle PT={\frac {{\sqrt {TPR(-TNR+1)}}+TNR-1}{(TPR+TNR-1)}}}"></span> ≈ 0.2686 ≈ 26.9%</li></ul> <p>This hypothetical screening test (fecal occult blood test) correctly identified two-thirds (66.7%) of patients with colorectal cancer.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>a<span class="cite-bracket">]</span></a></sup> Unfortunately, factoring in prevalence rates reveals that this hypothetical test has a high false positive rate, and it does not reliably identify colorectal cancer in the overall population of asymptomatic people (PPV = 10%). </p><p>On the other hand, this hypothetical test demonstrates very accurate detection of cancer-free individuals (NPV ≈ 99.5%). Therefore, when used for routine colorectal cancer screening with asymptomatic adults, a negative result supplies important data for the patient and doctor, such as ruling out cancer as the cause of gastrointestinal symptoms or reassuring patients worried about developing colorectal cancer. </p><p><a href="/wiki/Confidence_intervals" class="mw-redirect" title="Confidence intervals">Confidence intervals</a> for all the predictive parameters involved can be calculated, giving the range of values within which the true value lies at a given confidence level (e.g. 95%).<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Estimation_of_pre-_and_post-test_probability">Estimation of pre- and post-test probability</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Likelihood_ratios_in_diagnostic_testing&action=edit&section=6" title="Edit section: Estimation of pre- and post-test probability"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Pre-_and_post-test_probability" title="Pre- and post-test probability">Pre- and post-test probability</a></div> <p>The likelihood ratio of a test provides a way to estimate the <a href="/wiki/Pre-_and_post-test_probabilities" class="mw-redirect" title="Pre- and post-test probabilities">pre- and post-test probabilities</a> of having a condition. </p><p>With <i>pre-test probability</i> and <i>likelihood ratio</i> given, then, the <i>post-test probabilities</i> can be calculated by the following three steps:<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p> <dl><dd><span class="mwe-math-element"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle {\text{pretest odds}}={\frac {\text{pretest probability}}{1-{\text{pretest probability}}}}}"> <semantics> <mrow class="MJX-TeXAtom-ORD"> <mstyle displaystyle="true" scriptlevel="0"> <mrow class="MJX-TeXAtom-ORD"> <mtext>pretest odds</mtext> </mrow> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mfrac> <mtext>pretest probability</mtext> <mrow> <mn>1</mn> <mo>−<!-- − --></mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>pretest probability</mtext> </mrow> </mrow> </mfrac> </mrow> </mstyle> </mrow> <annotation encoding="application/x-tex">{\displaystyle {\text{pretest odds}}={\frac {\text{pretest probability}}{1-{\text{pretest probability}}}}}</annotation> </semantics> </math></span><img src="https://wikimedia.org/api/rest_v1/media/math/render/svg/1ac1c6fb6792c8256279bb12c3fddea5f15470c1" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -2.338ex; width:38.938ex; height:5.843ex;" alt="{\displaystyle {\text{pretest odds}}={\frac {\text{pretest probability}}{1-{\text{pretest probability}}}}}"></span></dd> <dd><span class="mwe-math-element"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle {\text{posttest odds}}={\text{pretest odds}}\times {\text{likelihood ratio}}}"> <semantics> <mrow class="MJX-TeXAtom-ORD"> <mstyle displaystyle="true" scriptlevel="0"> <mrow class="MJX-TeXAtom-ORD"> <mtext>posttest odds</mtext> </mrow> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>pretest odds</mtext> </mrow> <mo>×<!-- × --></mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>likelihood ratio</mtext> </mrow> </mstyle> </mrow> <annotation encoding="application/x-tex">{\displaystyle {\text{posttest odds}}={\text{pretest odds}}\times {\text{likelihood ratio}}}</annotation> </semantics> </math></span><img src="https://wikimedia.org/api/rest_v1/media/math/render/svg/02ab3258d403ff0dd4cbdd2753b8e7822e5e1057" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -0.671ex; width:46.582ex; height:2.509ex;" alt="{\displaystyle {\text{posttest odds}}={\text{pretest odds}}\times {\text{likelihood ratio}}}"></span></dd></dl> <p>In equation above, <i>positive post-test probability</i> is calculated using the <i>likelihood ratio positive</i>, and the <i>negative post-test probability</i> is calculated using the <i>likelihood ratio negative</i>. </p><p>Odds are converted to probabilities as follows:<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <dl><dd><span class="mwe-math-element"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle {\begin{aligned}(1)\ {\text{ odds}}={\frac {\text{probability}}{1-{\text{probability}}}}\end{aligned}}}"> <semantics> <mrow class="MJX-TeXAtom-ORD"> <mstyle displaystyle="true" scriptlevel="0"> <mrow class="MJX-TeXAtom-ORD"> <mtable columnalign="right left right left right left right left right left right left" rowspacing="3pt" columnspacing="0em 2em 0em 2em 0em 2em 0em 2em 0em 2em 0em" displaystyle="true"> <mtr> <mtd> <mo stretchy="false">(</mo> <mn>1</mn> <mo stretchy="false">)</mo> <mtext> </mtext> <mrow class="MJX-TeXAtom-ORD"> <mtext> odds</mtext> </mrow> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mfrac> <mtext>probability</mtext> <mrow> <mn>1</mn> <mo>−<!-- − --></mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>probability</mtext> </mrow> </mrow> </mfrac> </mrow> </mtd> </mtr> </mtable> </mrow> </mstyle> </mrow> <annotation encoding="application/x-tex">{\displaystyle {\begin{aligned}(1)\ {\text{ odds}}={\frac {\text{probability}}{1-{\text{probability}}}}\end{aligned}}}</annotation> </semantics> </math></span><img src="https://wikimedia.org/api/rest_v1/media/math/render/svg/ff07ee523340c6f3e37dd2915ef90af5ce3d41f9" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -2.338ex; width:28.672ex; height:5.843ex;" alt="{\displaystyle {\begin{aligned}(1)\ {\text{ odds}}={\frac {\text{probability}}{1-{\text{probability}}}}\end{aligned}}}"></span></dd></dl> <p>multiply equation (1) by (1 − probability) </p> <dl><dd><span class="mwe-math-element"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle {\begin{aligned}(2)\ {\text{ probability}}&={\text{odds}}\times (1-{\text{probability}})\\&={\text{odds}}-{\text{probability}}\times {\text{odds}}\end{aligned}}}"> <semantics> <mrow class="MJX-TeXAtom-ORD"> <mstyle displaystyle="true" scriptlevel="0"> <mrow class="MJX-TeXAtom-ORD"> <mtable columnalign="right left right left right left right left right left right left" rowspacing="3pt" columnspacing="0em 2em 0em 2em 0em 2em 0em 2em 0em 2em 0em" displaystyle="true"> <mtr> <mtd> <mo stretchy="false">(</mo> <mn>2</mn> <mo stretchy="false">)</mo> <mtext> </mtext> <mrow class="MJX-TeXAtom-ORD"> <mtext> probability</mtext> </mrow> </mtd> <mtd> <mi></mi> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>odds</mtext> </mrow> <mo>×<!-- × --></mo> <mo stretchy="false">(</mo> <mn>1</mn> <mo>−<!-- − --></mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>probability</mtext> </mrow> <mo stretchy="false">)</mo> </mtd> </mtr> <mtr> <mtd /> <mtd> <mi></mi> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>odds</mtext> </mrow> <mo>−<!-- − --></mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>probability</mtext> </mrow> <mo>×<!-- × --></mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>odds</mtext> </mrow> </mtd> </mtr> </mtable> </mrow> </mstyle> </mrow> <annotation encoding="application/x-tex">{\displaystyle {\begin{aligned}(2)\ {\text{ probability}}&={\text{odds}}\times (1-{\text{probability}})\\&={\text{odds}}-{\text{probability}}\times {\text{odds}}\end{aligned}}}</annotation> </semantics> </math></span><img src="https://wikimedia.org/api/rest_v1/media/math/render/svg/b92cdd23433d78284cc758bc89158c499f673ef4" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -2.338ex; width:45.365ex; height:5.843ex;" alt="{\displaystyle {\begin{aligned}(2)\ {\text{ probability}}&={\text{odds}}\times (1-{\text{probability}})\\&={\text{odds}}-{\text{probability}}\times {\text{odds}}\end{aligned}}}"></span></dd></dl> <p>add (probability × odds) to equation (2) </p> <dl><dd><span class="mwe-math-element"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle {\begin{aligned}(3)\ {\text{ probability}}+{\text{probability}}\times {\text{odds}}&={\text{odds}}\\{\text{probability}}\times (1+{\text{odds}})&={\text{odds}}\end{aligned}}}"> <semantics> <mrow class="MJX-TeXAtom-ORD"> <mstyle displaystyle="true" scriptlevel="0"> <mrow class="MJX-TeXAtom-ORD"> <mtable columnalign="right left right left right left right left right left right left" rowspacing="3pt" columnspacing="0em 2em 0em 2em 0em 2em 0em 2em 0em 2em 0em" displaystyle="true"> <mtr> <mtd> <mo stretchy="false">(</mo> <mn>3</mn> <mo stretchy="false">)</mo> <mtext> </mtext> <mrow class="MJX-TeXAtom-ORD"> <mtext> probability</mtext> </mrow> <mo>+</mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>probability</mtext> </mrow> <mo>×<!-- × --></mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>odds</mtext> </mrow> </mtd> <mtd> <mi></mi> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>odds</mtext> </mrow> </mtd> </mtr> <mtr> <mtd> <mrow class="MJX-TeXAtom-ORD"> <mtext>probability</mtext> </mrow> <mo>×<!-- × --></mo> <mo stretchy="false">(</mo> <mn>1</mn> <mo>+</mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>odds</mtext> </mrow> <mo stretchy="false">)</mo> </mtd> <mtd> <mi></mi> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>odds</mtext> </mrow> </mtd> </mtr> </mtable> </mrow> </mstyle> </mrow> <annotation encoding="application/x-tex">{\displaystyle {\begin{aligned}(3)\ {\text{ probability}}+{\text{probability}}\times {\text{odds}}&={\text{odds}}\\{\text{probability}}\times (1+{\text{odds}})&={\text{odds}}\end{aligned}}}</annotation> </semantics> </math></span><img src="https://wikimedia.org/api/rest_v1/media/math/render/svg/12bf5572367f8806ccf428081b08bf033d669afd" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -2.505ex; width:45.365ex; height:6.176ex;" alt="{\displaystyle {\begin{aligned}(3)\ {\text{ probability}}+{\text{probability}}\times {\text{odds}}&={\text{odds}}\\{\text{probability}}\times (1+{\text{odds}})&={\text{odds}}\end{aligned}}}"></span></dd></dl> <p>divide equation (3) by (1 + odds) </p> <dl><dd><span class="mwe-math-element"><span class="mwe-math-mathml-inline mwe-math-mathml-a11y" style="display: none;"><math xmlns="http://www.w3.org/1998/Math/MathML" alttext="{\displaystyle {\begin{aligned}(4)\ {\text{ probability}}={\frac {\text{odds}}{1+{\text{odds}}}}\end{aligned}}}"> <semantics> <mrow class="MJX-TeXAtom-ORD"> <mstyle displaystyle="true" scriptlevel="0"> <mrow class="MJX-TeXAtom-ORD"> <mtable columnalign="right left right left right left right left right left right left" rowspacing="3pt" columnspacing="0em 2em 0em 2em 0em 2em 0em 2em 0em 2em 0em" displaystyle="true"> <mtr> <mtd> <mo stretchy="false">(</mo> <mn>4</mn> <mo stretchy="false">)</mo> <mtext> </mtext> <mrow class="MJX-TeXAtom-ORD"> <mtext> probability</mtext> </mrow> <mo>=</mo> <mrow class="MJX-TeXAtom-ORD"> <mfrac> <mtext>odds</mtext> <mrow> <mn>1</mn> <mo>+</mo> <mrow class="MJX-TeXAtom-ORD"> <mtext>odds</mtext> </mrow> </mrow> </mfrac> </mrow> </mtd> </mtr> </mtable> </mrow> </mstyle> </mrow> <annotation encoding="application/x-tex">{\displaystyle {\begin{aligned}(4)\ {\text{ probability}}={\frac {\text{odds}}{1+{\text{odds}}}}\end{aligned}}}</annotation> </semantics> </math></span><img src="https://wikimedia.org/api/rest_v1/media/math/render/svg/e23000168868922489bb2cba27ad4164e7f2169e" class="mwe-math-fallback-image-inline mw-invert skin-invert" aria-hidden="true" style="vertical-align: -1.94ex; margin-bottom: -0.231ex; width:28.672ex; height:5.509ex;" alt="{\displaystyle {\begin{aligned}(4)\ {\text{ probability}}={\frac {\text{odds}}{1+{\text{odds}}}}\end{aligned}}}"></span></dd></dl> <p>hence </p> <ul><li>Posttest probability = Posttest odds / (Posttest odds + 1)</li></ul> <p>Alternatively, post-test probability can be calculated directly from the pre-test probability and the likelihood ratio using the equation: </p> <ul><li><b>P' = P0 × LR/(1 − P0 + P0×LR)</b>, where P0 is the pre-test probability, P' is the post-test probability, and LR is the likelihood ratio. This formula can be calculated algebraically by combining the steps in the preceding description.</li></ul> <p>In fact, <i>post-test probability</i>, as estimated from the <i>likelihood ratio</i> and <i>pre-test probability</i>, is generally more accurate than if estimated from the <i><a href="/wiki/Positive_predictive_value" class="mw-redirect" title="Positive predictive value">positive predictive value</a></i> of the test, if the tested individual has a different <i>pre-test probability</i> than what is the <i>prevalence</i> of that condition in the population. </p> <div class="mw-heading mw-heading3"><h3 id="Example">Example</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Likelihood_ratios_in_diagnostic_testing&action=edit&section=7" title="Edit section: Example"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Taking the medical example from above (20 true positives, 10 false negatives, and 2030 total patients), the <i>positive pre-test probability</i> is calculated as: </p> <ul><li>Pretest probability = (20 + 10) / 2030 = 0.0148</li> <li>Pretest odds = 0.0148 / (1 − 0.0148) = 0.015</li> <li>Posttest odds = 0.015 × 7.4 = 0.111</li> <li>Posttest probability = 0.111 / (0.111 + 1) = 0.1 or 10%</li></ul> <p>As demonstrated, the <i>positive post-test probability</i> is numerically equal to the <i>positive predictive value</i>; the <i>negative post-test probability</i> is numerically equal to (1 − <i>negative predictive value</i>). </p> <div class="mw-heading mw-heading2"><h2 id="Notes">Notes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Likelihood_ratios_in_diagnostic_testing&action=edit&section=8" title="Edit section: Notes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-lower-alpha"> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-16"><span 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Archived from <a rel="nofollow" class="external text" href="http://www.poems.msu.edu/InfoMastery/Diagnosis/likelihood_ratios.htm">the original</a> on 20 August 2002<span class="reference-accessdate">. Retrieved <span class="nowrap">4 April</span> 2009</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Likelihood+ratios&rft_id=http%3A%2F%2Fwww.poems.msu.edu%2FInfoMastery%2FDiagnosis%2Flikelihood_ratios.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALikelihood+ratios+in+diagnostic+testing" class="Z3988"></span></span> </li> <li id="cite_note-14"><span class="mw-cite-backlink"><b><a href="#cite_ref-14">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLinPiperPerdueRutter2016" class="citation journal cs1">Lin, Jennifer S.; Piper, Margaret A.; Perdue, Leslie A.; Rutter, Carolyn M.; Webber, Elizabeth M.; O'Connor, Elizabeth; Smith, Ning; Whitlock, Evelyn P. (21 June 2016). 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Page last edited: 1 February 2009</span> </li> <li id="cite_note-19"><span class="mw-cite-backlink"><b><a href="#cite_ref-19">^</a></b></span> <span class="reference-text"><a rel="nofollow" class="external autonumber" href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4441.0.55.002Explanatory+Notes5Jun+2012">[1]</a> from Australian Bureau of Statistics: A Comparison of Volunteering Rates from the 2006 Census of Population and Housing and the 2006 General Social Survey, Jun 2012, Latest ISSUE Released at 11:30 AM (CANBERRA TIME) 08/06/2012</span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Likelihood_ratios_in_diagnostic_testing&action=edit&section=10" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <dl><dt>Medical likelihood ratio repositories</dt></dl> <ul><li><a rel="nofollow" class="external text" href="https://www.doclogica.com">The Likelihood Ratio Database</a></li> <li><a rel="nofollow" class="external text" href="http://www.getthediagnosis.org">GetTheDiagnosis.org: A Database of Sensitivity and Specificity</a></li> <li><a rel="nofollow" class="external text" href="http://www.thennt.com/home-lr/">The NNT: LR Home</a></li></ul> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output .navbox-subgroup{width:100%}.mw-parser-output .navbox-group,.mw-parser-output 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rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Medical_research_studies" title="Template:Medical research studies"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Medical_research_studies" title="Template talk:Medical research studies"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Medical_research_studies" title="Special:EditPage/Template:Medical research studies"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Clinical_research_and_experimental_design" style="font-size:114%;margin:0 4em"><a href="/wiki/Clinical_research" title="Clinical research">Clinical research</a> and <a href="/wiki/Design_of_experiments" title="Design of experiments">experimental design</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Overview</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trial</a> <ul><li><a href="/wiki/Protocol_(science)" title="Protocol (science)">Trial protocols</a></li> <li><a href="/wiki/Adaptive_clinical_trial" class="mw-redirect" title="Adaptive clinical trial">Adaptive clinical trial</a></li></ul></li> <li><a href="/wiki/Academic_clinical_trials" class="mw-redirect" title="Academic clinical trials">Academic clinical trials</a></li> <li><a href="/wiki/Clinical_study_design" title="Clinical study design">Clinical study design</a></li> <li><a href="/wiki/Evidence-based_medicine" title="Evidence-based medicine">Evidence-based medicine</a></li> <li><a href="/wiki/Real_world_evidence" title="Real world evidence">Real world evidence</a></li> <li><a href="/wiki/Patient_and_public_involvement" title="Patient and public involvement">Patient and public involvement</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Scientific_control" title="Scientific control">Controlled study</a><br />(<a href="/wiki/Hierarchy_of_evidence#USA" title="Hierarchy of evidence">EBM I to II-1</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">Randomized controlled trial</a> <ul><li><a href="/wiki/Experiment" title="Experiment">Scientific experiment</a></li> <li><a href="/wiki/Blind_experiment" class="mw-redirect" title="Blind experiment">Blind experiment</a></li> <li><a href="/wiki/Open-label_trial" title="Open-label trial">Open-label trial</a></li></ul></li> <li><a href="/wiki/Adaptive_clinical_trial" class="mw-redirect" title="Adaptive clinical trial">Adaptive clinical trial</a> <ul><li><a href="/wiki/Platform_trial" title="Platform trial">Platform trial</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Observational_study" title="Observational study">Observational study</a><br />(<a href="/wiki/Hierarchy_of_evidence#USA" title="Hierarchy of evidence">EBM II-2 to II-3</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cross-sectional_study" title="Cross-sectional study">Cross-sectional study</a> vs. <a href="/wiki/Longitudinal_study" title="Longitudinal study">Longitudinal study</a>, <a href="/wiki/Ecological_study" title="Ecological study">Ecological study</a></li> <li><a href="/wiki/Cohort_study" title="Cohort study">Cohort study</a> <ul><li><a href="/wiki/Retrospective_cohort_study" title="Retrospective cohort study">Retrospective</a></li> <li><a href="/wiki/Prospective_cohort_study" title="Prospective cohort study">Prospective</a></li></ul></li> <li><a href="/wiki/Case%E2%80%93control_study" title="Case–control study">Case–control study</a> (<a href="/wiki/Nested_case%E2%80%93control_study" title="Nested case–control study">Nested case–control study</a>)</li> <li><a href="/wiki/Case_series" title="Case series">Case series</a></li> <li><a href="/wiki/Case_study" title="Case study">Case study</a></li> <li><a href="/wiki/Case_report" title="Case report">Case report</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Outcome_measure" title="Outcome measure">Measures</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epidemiological_methods#Measures_of_occurrence" class="mw-redirect" title="Epidemiological methods">Occurrence</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Incidence_(epidemiology)" title="Incidence (epidemiology)">Incidence</a>, <a href="/wiki/Cumulative_incidence" class="mw-redirect" title="Cumulative incidence">Cumulative incidence</a>, <a href="/wiki/Prevalence" title="Prevalence">Prevalence</a>, <a href="/wiki/Point_prevalence" class="mw-redirect" title="Point prevalence">Point prevalence</a>, <a href="/wiki/Period_prevalence" class="mw-redirect" title="Period prevalence">Period prevalence</a></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epidemiological_methods#Measures_of_association" class="mw-redirect" title="Epidemiological methods">Association</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Risk_difference" title="Risk difference">Risk difference</a>, <a href="/wiki/Number_needed_to_treat" title="Number needed to treat">Number needed to treat</a>, <a href="/wiki/Number_needed_to_harm" title="Number needed to harm">Number needed to harm</a>, <a href="/wiki/Risk_ratio" class="mw-redirect" title="Risk ratio">Risk ratio</a>, <a href="/wiki/Relative_risk_reduction" title="Relative risk reduction">Relative risk reduction</a>, <a href="/wiki/Odds_ratio" title="Odds ratio">Odds ratio</a>, <a href="/wiki/Hazard_ratio" title="Hazard ratio">Hazard ratio</a></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Population_impact_measure" title="Population impact measure">Population impact</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Attributable_fraction_among_the_exposed" title="Attributable fraction among the exposed">Attributable fraction among the exposed</a>, <a href="/wiki/Attributable_fraction_for_the_population" title="Attributable fraction for the population">Attributable fraction for the population</a>, <a href="/wiki/Preventable_fraction_among_the_unexposed" title="Preventable fraction among the unexposed">Preventable fraction among the unexposed</a>, <a href="/wiki/Preventable_fraction_for_the_population" title="Preventable fraction for the population">Preventable fraction for the population</a></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epidemiological_methods#Other_measures" class="mw-redirect" title="Epidemiological methods">Other</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Clinical_endpoint" title="Clinical endpoint">Clinical endpoint</a>, <a href="/wiki/Virulence" title="Virulence">Virulence</a>, <a href="/wiki/Infectivity" title="Infectivity">Infectivity</a>, <a href="/wiki/Mortality_rate" title="Mortality rate">Mortality rate</a>, <a href="/wiki/Morbidity" class="mw-redirect" title="Morbidity">Morbidity</a>, <a href="/wiki/Case_fatality_rate" title="Case fatality rate">Case fatality rate</a>, <a href="/wiki/Specificity_and_sensitivity" class="mw-redirect" title="Specificity and sensitivity">Specificity and sensitivity</a>, <a class="mw-selflink selflink">Likelihood-ratios</a>, <a href="/wiki/Pre-_and_post-test_probability" title="Pre- and post-test probability">Pre- and post-test probability</a></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Trial/test types</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/In_vitro" title="In vitro">In vitro</a></li> <li><a href="/wiki/In_vivo" title="In vivo">In vivo</a></li> <li><a href="/wiki/Animal_testing" title="Animal testing">Animal testing</a></li> <li><a href="/wiki/Animal_testing_on_non-human_primates" title="Animal testing on non-human primates">Animal testing on non-human primates</a></li> <li><a href="/wiki/First-in-man_study" class="mw-redirect" title="First-in-man study">First-in-man study</a></li> <li><a href="/wiki/Multicenter_trial" title="Multicenter trial">Multicenter trial</a></li> <li><a href="/wiki/Seeding_trial" title="Seeding trial">Seeding trial</a></li> <li><a href="/wiki/Vaccine_trial" title="Vaccine trial">Vaccine trial</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Analysis_of_clinical_trials" title="Analysis of clinical trials">Analysis of clinical trials</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Risk%E2%80%93benefit_ratio" title="Risk–benefit ratio">Risk–benefit ratio</a></li> <li><a href="/wiki/Systematic_review" title="Systematic review">Systematic review</a></li> <li><a href="/wiki/Reproducibility" title="Reproducibility">Replication</a></li> <li><a href="/wiki/Meta-analysis" title="Meta-analysis">Meta-analysis</a></li> <li><a href="/wiki/Intention-to-treat_analysis" title="Intention-to-treat analysis">Intention-to-treat analysis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Interpretation of results</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Selection_bias" title="Selection bias">Selection bias</a></li> <li><a href="/wiki/Survivorship_bias" title="Survivorship bias">Survivorship bias</a></li> <li><a href="/wiki/Correlation_does_not_imply_causation" title="Correlation does not imply causation">Correlation does not imply causation</a></li> <li><a href="/wiki/Null_result" title="Null result">Null result</a></li> <li><a href="/wiki/Sex_as_a_biological_variable" title="Sex as a biological variable">Sex as a biological variable</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><b><a href="/wiki/Category:Clinical_research" title="Category:Clinical research">Category</a></b></li> <li><b><a href="/wiki/Glossary_of_clinical_research" title="Glossary of clinical research">Glossary</a></b></li> <li><b><a href="/wiki/List_of_clinical_research_topics" class="mw-redirect" title="List of clinical research topics">List of topics</a></b></li></ul> </div></td></tr></tbody></table></div> <!-- NewPP limit report Parsed by mw‐web.eqiad.main‐5dc468848‐vnxdp Cached time: 20241122141409 Cache expiry: 2592000 Reduced expiry: false Complications: [vary‐revision‐sha1, show‐toc] CPU time usage: 0.487 seconds Real time usage: 0.780 seconds Preprocessor visited node count: 1859/1000000 Post‐expand include size: 78662/2097152 bytes Template argument size: 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