544
to reproduce the 2 summary ROC
curves that appear in Fig. 1 of our
article without too much further dif-
ficulty. This is an example of how the
intermediate calculations worksheets
provided me valuable assistance.
In summary, for Excel users who
wish to combine and analyze the
results of multiple independent stud-
ies of a test’s diagnostic accuracy,
dr-ROC provides a reasonably sim-
ple and flexible way to estimate and
plot a summary ROC curve along
with many related statistics. How-
ever, given its limited scope, the
price of the software may seem a bit
high to some potential users.
References
1. Littenberg B, Moses LE. Estimating diagnostic
accuracy from multiple conflicting reports: a new
meta-analytic method. Med Decis Making 1993;
13:313–21.
2. Vamvakas EC. Meta-analysis of studies of the
diagnostic accuracy of laboratory tests: a review
of the concepts and methods. Arch Pathol Lab
Med 1998;122:675– 86.
3. Laterza OF, Price CP, Scott MG. Cystatin C: an
improved estimator of glomerular filtration rate?
2002;48:699 –707.
Curtis A. Parvin
Pathology and Immunology
School of Medicine
Washington University
St. Louis, MO 63110
DOI: 10.1373/clinchem.2005.057687
Pediatric References Intervals, 5th
Edition (formerly Pediatric Reference
Ranges). Steven J. Soldin, Carlo Brug-
nara, and Edward C. Wong, editors;
Jocelyn M. Hicks, editor emeritus.
Washington, DC: AACC Press, 2005,
257 pp., $75.00 ($60.00 AACC mem-
bers), softcover. ISBN 1-594250-32-4.
With this fifth edition, a successful
publication appropriately modifies
its title, substituting the term
“ranges” with “intervals”. The term
“range” refers to the entire range of
values from the reference popula-
tion, from minimum to maximum,
whereas the reference interval refers
to that between two limits, usually
95% of the population. However, the
change in the title has not been intro-
duced in the text, where the term
Book, Software, and Web Site Reviews
“reference ranges” remains in all of
the paragraphs of the preface and
at the top of every second page
throughout.
This book is essentially the same as
the fourth edition from 2003, with
the addition of few new measure-
ments [coenzyme Q10, cystatin C,
nucleated red blood cell count (abso-
lute and relative)] and some new
data on iron binding capacity.
The text presents the data in a very
schematic but informative format
that provides information relative to
age- and sex-related reference inter-
vals, types of specimens, population
sources, and also to the analytical
methodology, references, and the
statistical basis. The names of the
tests are reported alphabetically, and
the format is the same for all ana-
lytes.
This book is a very valuable source
of difficult-to-obtain data for more
than 250 chemistry and hematology
analytes. The chemistry part is ex-
tremely rich in its coverage of eso-
teric analytes (e.g., apolipoprotein
CII, hyaluronic acid, or glutathione
peroxidase activity), whereas the he-
matology part is less detailed (e.g.,
lymphocyte subclasses are missing).
For most of the analytes, 3 to 4
different sources of data are pro-
vided covering the most commonly
used analytical technologies. The
reader is presented with the means
to critically evaluate the data pre-
sented (analytical method, statistical
basis, bibliographic reference to go
into details) and to decide whether
they are appropriate for his or her
own situation. The only criticism I
have is the lack of comments and
critical evaluations of the presented
data, which for some analytes are
sometimes contradictory or which
present large differences according
to different bibliographic sources.
Pediatric Reference Intervals is a
must, not only for laboratorians, but
also for clinicians (such as pediatri-
cians, endocrinologists, hematolo-
gists); however, for those who al-
ready own a copy of the fourth
edition that is not yet worn out, the
few new pages added to this edition
do not justify replacement.
Ferruccio Ceriotti
Diagnostica e Ricerca
San Raffaele
Scientific Institute
San Raffaele Hospital
Milan, Italy 20132
DOI: 10.1373/clinchem.2005.058123
Reference Intervals: A User’s
Guide. Paul S. Horn and Amadeo J.
Pesce. Washington, DC: AACC
Press, 2005, 115 pp., $61.00 ($49.00
AACC members), softcover (CD-
ROM included). ISBN 1-59425-035-9.
This book has the ambitious goal of
bridging theory and practice in the
complex field of reference intervals.
The text comprises only 115 pages
but includes a CD-ROM that is a
virtual gold mine of both data and
computer routines. The CD-ROM
provides data from NHANES III
(27 900 individuals; 33 analytes) in
both SAS® and Microsoft Excel® for-
mats, making it extremely useful as a
source of information and as a way
of evaluating different computa-
tional techniques. Moreover, there
are the already calculated reference
intervals, both nonparametric and
with the robust estimator, as ex-
plained in the text on the NHANES
data and on the Fernald cohort (a
group of residents, monitored for 17
years, living near a uranium ore pro-
cessing plant). Finally, the SAS pro-
grams to calculate reference intervals
are provided.
The book is small, but the content
is rich and represents a summation
of the impressive work of the authors
in this field over the last 30 years. It
illustrates in detail various methods
involved in the determination of ref-
erence intervals. Beginning with the
guidelines developed by the Interna-
tional Federation of Clinical Chemis-
try and Laboratory Medicine (IFCC)
and the Clinical and Laboratory
Standards Institute (CLSI; formerly
NCCLS), the Guide discusses possi-
ble alternative approaches to cope
with the 2 main problems encoun-
tered when attempting to determine
reference intervals—namely, the dif-

ficulty of obtaining a sufficient num-
ber of individuals for the reference
population and the possible presence
of outliers.
The book has many good points.
The authors have a clear and pro-
found knowledge of the subject (I
very much like the concept of “Med-
ical Heritage”), extremely high statis-
tical competence, and a clear under-
standing of the everyday problems.
It gives an ample array of ap-
proaches that could be applied suc-
cessfully to different situations, and
it is a valuable source of biblio-
graphic information as well as of
formulas and mathematical defini-
tions.
Nonetheless, I believe that the au-
thors only partially reached their
goal. The main limitation for such a
book, that wants to be a “user’s
guide”, is the level of mathematical
competence needed. In particular,
chapters 5 and 6, but also many other
Clinical Chemistry 52, No. 3, 2006
parts of the book, are written more
for a statistician than for the average
laboratorian. If most of the mathe-
matics and statistical equations were
included in specific appendices, this
book would have been much easier
to read. A second criticism is that it
seems more like a collage of previous
articles, with some loose connecting
sections, rather than a unified trea-
tise. For this reason, it is not easy to
derive practical directions on how to
approach the determination of refer-
ence intervals in everyday practice.
The chapter “Case Histories” gives
helpful suggestions, but something
like an “executive summary” or a
flow chart would have been useful.
As a matter of fact, chapter 15, “Con-
clusions”, is too basic and does not
provide the reader with sufficient
guidance to face real-life problems. It
is evident that a single solution for
any situation does not exist, but from
the book’s title and its back cover
545
page, I expected clearer statements
on which way the authors consider
the best to follow (or at least the less
dangerous).
Apart from these criticisms, the
book is a little gem and cannot be
overlooked by anyone interested in
reference values.
Ferruccio Ceriotti
Diagnostica e Ricerca
San Raffaele S.p.A.
Scientific Institute
San Raffaele Hospital
Milan, Italy 20132
Editor’s Note: The author is Chair
of the IFCC Committee “Reference
Intervals and Decision Limits”.
DOI: 10.1373/clinchem.2005.058131