Book III: Scientific and Research Applications in Medical Care: The “Iron Screen”: Progressive Development of an Interpretative Analysis of Body Iron Status

The Iron Screen, a sequential Bayesian decision-making model for the assessment of body iron stores in man, is a special example of the blending of computer support, decision analysis, and multivariate statistical techniques in medicine. This model, originally developed and tested in patients with chronic diseases and a question of iron deficiency anemia, has recently been broadened to include all pateints for whom body iron stores must be determined. In this report we describe operational experience with the Iron Screen in over 1100 cases seen at the Dartmouth-Hitchcock Medical Center, where the model was developed. The Iron Screen remains valid when broadened from the chronic disease setting to the ambulatory care setting, largely due to the power of serum ferritin as an isolated diagnostic test in uncomplicated anemias. We have used cost-effectiveness analysis as an aid to the export of the Iron Screen package, and show in this report how the decision whether or not to institute this diagnostic aid may be made for various clinical settings.