Transfer of hypercalcemia discriminant functions between local hospitals

Abstract

Transferability of discriminant functions is potentially useful both from an economical point of view and because, in general, medical knowledge, in this case discriminant functions, should be transferable. In the present study we have evaluated the transferability of discriminant functions, estimated from routine laboratory analysis, age and sex in two consecutively recorded populations with hypercalcemia including 162 and 257 patients with hypercalcemia. Discriminant functions were developed for each sex to distinguish between hypercalcemia associated with malignancy and hypercalcemia associated with other medical diseases. The total diagnostic accuracy in Herlev was 82 and 78%, in women and men, and increased to 87 and 86% in both sexes considering cases classified with posterior probability levels of 60%. In Hvidovre the total diagnostic accuracy was 81 and 84% in women and men, and increased to 83 and 89% at posterior probability levels higher than 60%. Transfer of the discriminant functions between the hospitals was followed by a decrease in diagnostic accuracy of 6–16%. At a posterior probability of 60% the diagnostic accuracies were 79% or more in the receiving hospital, in both sexes, except for men in Hvidovre. In relation to these results the concept of genuine and non-genuine transfer factors is introduced and discussed.