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A junior doctor presents the results of a validation study assessing the Ottawa ankle rule in patients presenting to the Emergency Department with ankle injuries. She states that the rule demonstrated an accuracy of 65% for detecting ankle fractures and therefore concludes that it is a reliable test for excluding fracture without radiography.
The supervising consultant explains that this interpretation is potentially misleading.
Which of the following best explains the principal limitation of accuracy as a diagnostic test characteristic?

A. Accuracy determines whether a test is useful for ruling out disease

B. Accuracy is unaffected by disease prevalence

C. Accuracy reflects the proportion of all correctly classified results, but does not distinguish between false negative and false positive errors

D. Accuracy reflects the probability of disease following a positive test result

E. Accuracy uses only patients with confirmed disease in its calculation

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References

https://www.rcemlearning.co.uk/critical-appraisal-dictionary/

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