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American Academy of Pediatrics
Commentary

Interval Likelihood Ratios and the Diagnostic Process

Stephen M. Downs
Pediatrics January 2021, 147 (1) e2020037721; DOI: https://doi.org/10.1542/peds.2020-037721
Stephen M. Downs
Wake Forest University, Winston Salem, North Carolina
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  • Abbreviations:
    ILR —
    interval likelihood ratio
    LE —
    leukocyte esterase
    UA —
    urine analysis
    UTI —
    urinary tract infection
  • In this issue of Pediatrics, Liang et al1 apply the concept of interval likelihood ratios (ILRs) to the diagnosis of urinary tract infections (UTIs) in children under the age of 2 years. The authors conducted a cross-sectional study of a cohort of children <2 years of age who had a urine culture and urine analysis (UA) simultaneously obtained from their emergency department. Their analysis, in contrast to most previous reports, derives ILRs for the scaled results of the UA relative to the diagnosis of UTIs.

    Most readers will be familiar with the terms sensitivity and specificity. ILRs are closely related to sensitivity and specificity but have at least 2 advantages. First, a separate ILR can be derived for each value of a test result when there can be more than just positive or negative results. For example, a urine dipslide can quantify the presence of leukocyte esterase (LE) as trace, 1+, 2+, or 3+. Liang et al1 showed 3+ LE increases the probability a child has …

    Address correspondence to Stephen M. Downs, MD, MS, Center for Biomedical Informatics, Wake Forest Baptist Health, 486 N Patterson Ave, Winston Salem, NC 27101. E-mail: sdowns{at}wakehealth.edu

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    Pediatrics
    Vol. 147, Issue 1
    1 Jan 2021
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    Interval Likelihood Ratios and the Diagnostic Process
    Stephen M. Downs
    Pediatrics Jan 2021, 147 (1) e2020037721; DOI: 10.1542/peds.2020-037721

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    Interval Likelihood Ratios and the Diagnostic Process
    Stephen M. Downs
    Pediatrics Jan 2021, 147 (1) e2020037721; DOI: 10.1542/peds.2020-037721
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