Diagnosis: Toxic! - Trying to apply approaches of clinical diagnostics and prevalence in toxicology considerations

Sebastian Hoffmann, Thomas Hartung

Research output: Contribution to journalReview articlepeer-review

62 Scopus citations


The assessment of relevance of toxicological testing was compared with approaches of diagnostic medicine, a discipline that faces a comparable situation. Considering the work of a toxicologist as setting a diagnosis for compounds, assessment tools for diagnostic tests were transferred to toxicological tests. In clinical diagnostics, test uncertainty is well accepted and incorporated in this assessment. Furthermore, prevalence information is considered to evaluate the gain in information resulting from the application of a test. Several common toxicological scenarios, in which test uncertainty and prevalence are combined, are discussed including the interdependence of test accuracy, prevalence and predictive values or the sequential application of a screening and a confirmatory test. In addition, real prevalences derived from prevalences determined by an imperfect test are presented. We conclude that information on prevalences of toxic health effects is required to allow a complete assessment of the relevance of toxicological test. In this process, lessons can be learned from evidence-based approaches in clinical diagnostics.

Original languageEnglish (US)
Pages (from-to)422-428
Number of pages7
JournalToxicological Sciences
Issue number1
StatePublished - May 2005
Externally publishedYes


  • Biometry
  • Evidence-based medicine
  • Prevalence
  • Reference standard
  • Risk assessment
  • Validation

ASJC Scopus subject areas

  • Toxicology


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