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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In a recent article in <span class="elsevierStyleItalic">Medicina Intensiva</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Professor Ramos-Vera introduced the clinical use of Bayes factors&#44; also known as likelihood ratios &#40;LR&#41;&#46; The author modified the classic Jeffreys scale<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> to make LRs more interpretable in the daily clinical practice&#46; With this idea of applicability&#44; it seems apparent the so-called &#8220;Weights of Evidence&#8221; should also become more widely accepted in intensive care medicine&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The weight of evidence &#40;WoE&#41; is no more than ten times the decimal logarithm of an LR&#46; Its unit of measurement is the deciban&#46; Therefore&#44;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Positive WoE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10 &#42; log10 &#40;positive LR&#41; decibans</p><p id="par0020" class="elsevierStylePara elsevierViewall">Negative WoE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10 &#42; log10 &#40;negative LR&#41; decibans</p><p id="par0025" class="elsevierStylePara elsevierViewall">It was Alan Turing who invented the WoEs as the basic statistical method used to decipher the Nazi&#39;s &#8220;Enigma&#8221; code&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> A deciban is the smallest change in the weight of evidence that can be directly perceived by human intuition&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Let&#39;s look at a specific example comparing the use of LVs and WoEs in a clinical case&#46; In a recent <span class="elsevierStyleItalic">Medicina Intensiva</span> publication&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> the diagnostic accuracy of 6 massive haemorrhage &#40;MH&#41; prediction scales in polytraumatised patients was evaluated&#46; With the data from 4 of these scales&#44; we have prepared <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">We can see by looking at it that the meaning of LRs&#44; especially LR for negatives&#44; is a little difficult to interpret&#46; The fact that the measurement scale is different for the positives &#40;from 1 to infinity&#41; and for the negatives &#40;from 0 to 1&#41; greatly contributes to this&#46; The authors in using the inverse of negative LR might have caused even more confusion&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">On the contrary&#44; the use of decibans here could be very illustrative&#46; The logarithmic transformation of the LRs means that both WoEs are expressed in a single measurement scale&#46; A positive deciban could be used to confirm a disease and a negative one to rule it out&#46; And in magnitude&#44; decibans are interpreted similarly to the marks obtained in secondary school&#46; All pupils know that an eight is not the same as obtaining a three&#46; A weighting of &#43;7&#46;5 decibans means passing an exam of &#8220;confirmatory test&#8221; with a good grade&#44; whereas a weighting of &#8722;3&#46;5 decibans is not passing an exam of &#8220;rejection test&#8221;&#46; Like in school&#44; the thresholds are &#43;5 decibans for confirmation and -5 decibans for rejection of a disease&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; we can see that three scales &#40;ETS&#44; TASH and PWH&#41; are good ways of ruling out MH&#58; the average weight of their negative is less than &#8722;8 decibans&#44; and the probability that the three could be good rejection tests &#40;weight<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#60;</span><span class="elsevierStyleHsp" style=""></span>&#8722;5 decibans&#41; is close to 1&#46; And we have a 0&#46;517 probability that ETS is an excellent &#40;weight<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#60;</span><span class="elsevierStyleHsp" style=""></span>&#8722;10 decibans&#41; scale to reject MH&#46; The authors did not realise the importance of this result&#46; There is another clinical result that also went unnoticed&#46; A positive on the Larson scale weights &#43;5&#46;07 decibans&#46; Although the confirmation capacity is not excellent&#44; the probability that this could be a good confirmatory test &#40;weight<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#62;</span><span class="elsevierStyleHsp" style=""></span>&#43;5 decibans&#41; is 0&#46;548&#44; well above the other three scales &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This can be important in a clinical setting when accurately trying to confirm the appearance of an MH&#44; for example to carry out adequate triage in an accident with multiple victims&#46; In this scenario&#44; none of the other three scales are adequate&#46; With the use of decibans we can see the importance&#46; Alan Turing would agree&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;1&#41; ETS scale&#58; Emergency Transfusion Score&#59; &#40;2&#41; TASH scale&#58; Trauma Associated Severe Haemorrhage&#59; &#40;3&#41; PWH scale&#58; <span class="elsevierStyleItalic">Prince of Wales Hospital&#47;Rainer</span>&#59; &#40;4&#41; Larson scale&#59; LR positive&#58; Likelihood Ratio of a positive result&#59; LR negative&#58; Likelihood Ratio of a negative result&#59; WoE positive&#58; weight of the evidence of a positive result&#59; WoE negative&#58; weight of the evidence of a negative result&#59; good as a confirmatory test&#58; WoE positive<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#62;</span><span class="elsevierStyleHsp" style=""></span>&#43; 5 decibans&#59; excellent as a confirmatory test&#58; WoE positive<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#62;</span><span class="elsevierStyleHsp" style=""></span>&#43;10 decibans&#59; good as a rejection test&#58; WoE positive<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#60;</span><span class="elsevierStyleHsp" style=""></span>&#8722;5 decibans&#59; excellent as a rejection test&#58; WoE positive<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#60;</span><span class="elsevierStyleHsp" style=""></span>&#8722;10 decibans&#46;</p>"
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Letter to the Editor
Decibans: It is time to weigh the evidence about diagnostic accuracy
Decibanes: es hora de sopesar la evidencia sobre la exactitud diagnóstica
V. Modesto i Alaponta,
Autor para correspondencia
vicent.modesto@gmail.com

Corresponding author.
, A. Medina-Villanuevab
a Hospital Universitari I Politècnic La Fe, València, Spain
b Hospital Universitario Central de Asturias, Oviedo, Spain
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        "titulo" => "Decibanes&#58; es hora de sopesar la evidencia sobre la exactitud diagn&#243;stica"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In a recent article in <span class="elsevierStyleItalic">Medicina Intensiva</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Professor Ramos-Vera introduced the clinical use of Bayes factors&#44; also known as likelihood ratios &#40;LR&#41;&#46; The author modified the classic Jeffreys scale<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> to make LRs more interpretable in the daily clinical practice&#46; With this idea of applicability&#44; it seems apparent the so-called &#8220;Weights of Evidence&#8221; should also become more widely accepted in intensive care medicine&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The weight of evidence &#40;WoE&#41; is no more than ten times the decimal logarithm of an LR&#46; Its unit of measurement is the deciban&#46; Therefore&#44;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Positive WoE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10 &#42; log10 &#40;positive LR&#41; decibans</p><p id="par0020" class="elsevierStylePara elsevierViewall">Negative WoE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10 &#42; log10 &#40;negative LR&#41; decibans</p><p id="par0025" class="elsevierStylePara elsevierViewall">It was Alan Turing who invented the WoEs as the basic statistical method used to decipher the Nazi&#39;s &#8220;Enigma&#8221; code&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> A deciban is the smallest change in the weight of evidence that can be directly perceived by human intuition&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Let&#39;s look at a specific example comparing the use of LVs and WoEs in a clinical case&#46; In a recent <span class="elsevierStyleItalic">Medicina Intensiva</span> publication&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> the diagnostic accuracy of 6 massive haemorrhage &#40;MH&#41; prediction scales in polytraumatised patients was evaluated&#46; With the data from 4 of these scales&#44; we have prepared <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">We can see by looking at it that the meaning of LRs&#44; especially LR for negatives&#44; is a little difficult to interpret&#46; The fact that the measurement scale is different for the positives &#40;from 1 to infinity&#41; and for the negatives &#40;from 0 to 1&#41; greatly contributes to this&#46; The authors in using the inverse of negative LR might have caused even more confusion&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">On the contrary&#44; the use of decibans here could be very illustrative&#46; The logarithmic transformation of the LRs means that both WoEs are expressed in a single measurement scale&#46; A positive deciban could be used to confirm a disease and a negative one to rule it out&#46; And in magnitude&#44; decibans are interpreted similarly to the marks obtained in secondary school&#46; All pupils know that an eight is not the same as obtaining a three&#46; A weighting of &#43;7&#46;5 decibans means passing an exam of &#8220;confirmatory test&#8221; with a good grade&#44; whereas a weighting of &#8722;3&#46;5 decibans is not passing an exam of &#8220;rejection test&#8221;&#46; Like in school&#44; the thresholds are &#43;5 decibans for confirmation and -5 decibans for rejection of a disease&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; we can see that three scales &#40;ETS&#44; TASH and PWH&#41; are good ways of ruling out MH&#58; the average weight of their negative is less than &#8722;8 decibans&#44; and the probability that the three could be good rejection tests &#40;weight<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#60;</span><span class="elsevierStyleHsp" style=""></span>&#8722;5 decibans&#41; is close to 1&#46; And we have a 0&#46;517 probability that ETS is an excellent &#40;weight<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#60;</span><span class="elsevierStyleHsp" style=""></span>&#8722;10 decibans&#41; scale to reject MH&#46; The authors did not realise the importance of this result&#46; There is another clinical result that also went unnoticed&#46; A positive on the Larson scale weights &#43;5&#46;07 decibans&#46; Although the confirmation capacity is not excellent&#44; the probability that this could be a good confirmatory test &#40;weight<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#62;</span><span class="elsevierStyleHsp" style=""></span>&#43;5 decibans&#41; is 0&#46;548&#44; well above the other three scales &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This can be important in a clinical setting when accurately trying to confirm the appearance of an MH&#44; for example to carry out adequate triage in an accident with multiple victims&#46; In this scenario&#44; none of the other three scales are adequate&#46; With the use of decibans we can see the importance&#46; Alan Turing would agree&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;1&#41; ETS scale&#58; Emergency Transfusion Score&#59; &#40;2&#41; TASH scale&#58; Trauma Associated Severe Haemorrhage&#59; &#40;3&#41; PWH scale&#58; <span class="elsevierStyleItalic">Prince of Wales Hospital&#47;Rainer</span>&#59; &#40;4&#41; Larson scale&#59; LR positive&#58; Likelihood Ratio of a positive result&#59; LR negative&#58; Likelihood Ratio of a negative result&#59; WoE positive&#58; weight of the evidence of a positive result&#59; WoE negative&#58; weight of the evidence of a negative result&#59; good as a confirmatory test&#58; WoE positive<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#62;</span><span class="elsevierStyleHsp" style=""></span>&#43; 5 decibans&#59; excellent as a confirmatory test&#58; WoE positive<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#62;</span><span class="elsevierStyleHsp" style=""></span>&#43;10 decibans&#59; good as a rejection test&#58; WoE positive<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#60;</span><span class="elsevierStyleHsp" style=""></span>&#8722;5 decibans&#59; excellent as a rejection test&#58; WoE positive<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#60;</span><span class="elsevierStyleHsp" style=""></span>&#8722;10 decibans&#46;</p>"
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ETS &#40;1&#41;</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">128</td><td class="td" title="\n
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                  \t\t\t\t">378</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Prevalence of massive haemorrhage</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="left" valign="middle">0&#46;1</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;098</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">WoE positive &#40;decibans&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Probability of being CONFIRMATORY&#8230;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="middle">0&#46;00987</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="middle">0&#46;0278</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="middle">0&#46;00757</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="middle">0&#46;548</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Excellent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="middle">0</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="middle">0</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="middle">0</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="middle">0</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">WoE negative &#40;decibans&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;10&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;17&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;8&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;7&#46;45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Probability of being REJECTION&#8230;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Good&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="left" valign="middle">0&#46;367</td><td class="td" title="\n
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