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Understanding diagnostic tests 3: receiver operating characteristic curves
Abstract
The results of many clinical tests are quantitative and are provided on a continuous scale. To help decide the presence or absence of disease, a cut‐off point for ‘normal’ or ‘abnormal’ is chosen. The sensitivity and specificity of a test vary according to the level that is chosen as the cut‐off point. The receiver operating characteristic (ROC) curve, a graphical technique for describing and comparing the accuracy of diagnostic tests, is obtained by plotting the sensitivity of a test on the y axis against 1‐specificity on the x axis. Two methods commonly used to establish the optimal cut‐off point include the point on the ROC curve closest to (0, 1) and the Youden index. The area under the ROC curve provides a measure of the overall performance of a diagnostic test. In this paper, the author explains how the ROC curve can be used to select optimal cut‐off points for a test result, to assess the diagnostic accuracy of a test, and to compare the usefulness of tests. Conclusion: The ROC curve is obtained by calculating the sensitivity and specificity of a test at every possible cut‐off point, and plotting sensitivity against 1‐specificity. The curve may be used to select optimal cut‐off values for a test result, to assess the diagnostic accuracy of a test, and to compare the usefulness of different tests.
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“The AUC values ranged from .63 to .76 and were considered in acceptable range (Akobeng, 2007; Fischer et al., 2003).”
From Exercise habit formation in new gym members: a longitudinal study (2015) · cites this paper as Akobeng, 2007
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Estimation of the Youden Index and its Associated Cutoff Point
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Understanding diagnostic tests 1: sensitivity, specificity and predictive values
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Self-citationStatistics Notes: Diagnostic tests 3: receiver operating characteristic plots
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Metadata
- Authors
- Akobeng, A. K.
- Corresponding author
- Akobeng, Anthony K
- ORCID
- Akobeng, Anthony K
- Venue
- Acta Paediatrica
- Publisher
- Wiley
- Published
- 2007-03-21
- Volume
- 96
- Issue
- 5
- Pages
- 644-647
- ISSN
- 0365-1436 (ISSN-L)
- 0803-5253
- 1651-2227
- OpenAlex
- W2073887351
- Cited by
- 1,882
- References
- 17
- Citations by year
- 2026: 53 · 2025: 95 · 2024: 135 · 2023: 138 · 2022: 167 · 2021: 156 · 2020: 131 · 2019: 116 · 2018: 102 · 2017: 120 · 2016: 113 · 2015: 117 · 2014: 117 · 2013: 98 · 2012: 76
- FWCI
- 29.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Paediatrica (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Keywords
- receiver operating characteristic, diagnostic accuracy, cut-point selection, sensitivity, specificity, Youden index, area under the ROC curve, diagnostic test comparison
- MeSH terms
- C-Reactive Protein, Calcitonin, Humans, Leukocyte Count, Protein Precursors, ROC Curve, Sensitivity and Specificity, Shock, Septic
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