Informal identification of outliers in medical data

Informal box plot identification of outliers in realworld medical data was studied. Box plots were used to detect univariate outliers directly whereas the box plotted Mahalanobis distances identified multivariate outliers. Vertigo and female urinary incontinence data were used in the tests. The removal of outliers increased the descriptive classification accuracy of discriminant analysis functions and nearest neighbour method, while the predictive ability of these methods reduced somewhat. Outliers were also evaluated subjectively by expert physicians, who found most of the multivariate outliers to truly be outliers in their area. The experts sometimes disagreed with the method on univariate outliers. This happened, for example, in heterogeneous diagnostic groups where also extreme values are natural. The informal method may be used for straightforward identification of suspicious data or as a tool to collect abnormal cases for an in-depth analysis.