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5 - Critical appraisal of studies of diagnostic tests

Published online by Cambridge University Press:  04 August 2010

Thomas B. Newman  and
Michael A. Kohn
Thomas B. Newman
Affiliation:
University of California, San Francisco
Michael A. Kohn
Affiliation:
University of California, San Francisco
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Summary

Introduction

We have learned how to quantify the reliability (Chapter 2) and accuracy (Chapters 3 and 4) of diagnostic tests. In this chapter, we turn to critical appraisal of studies of diagnostic tests, with an emphasis on problems with study design that affect the interpretation or credibility of the results. After a general discussion of an approach to studies of diagnostic tests, we will review some common biases to which studies of test accuracy are uniquely or especially susceptible and conclude with an introduction to systematic reviews of studies of diagnostic tests.

General approach

A general approach to critical appraisal of studies of diagnostic tests is to break the study down into its component parts and consider strengths and weaknesses of each, as outlined in Table 5.1. Begin with the research question: is it a question to which you really want to know the answer? Is the test (or history or physical examination finding) being studied one that you have used or could use for your patients? Is the entity being diagnosed one that is important?

Next, consider the study design. All study designs (cross-sectional, case–control, cohort, randomized trial, etc.) have strengths and weaknesses. Watch out for studies of diagnostic tests with a case–control design, in which subjects with the disease are sampled separately from those without the disease.

Type
Chapter
Information
Evidence-Based Diagnosis , pp. 94 - 115
Publisher: Cambridge University Press
Print publication year: 2009

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References

Bossuyt, P. M., Reitsma, J. B., et al. (2003). “Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.” Br Med J 326(7379): 41–4.CrossRefGoogle ScholarPubMed
Deeks, J. J. (2001). “Systematic reviews in health care: Systematic reviews of evaluations of diagnostic and screening tests.” Br Med J 323(7305): 157–62.CrossRefGoogle ScholarPubMed
Eshed, I., Gorenstein, A., et al. (2004). “Intussusception in children: can we rely on screening sonography performed by junior residents?” Pediatr Radiol 34(2): 134–7.CrossRefGoogle ScholarPubMed
Lachs, M. S., Nachamkin, I., et al. (1992). “Spectrum bias in the evaluation of diagnostic tests: lessons from the rapid dipstick test for urinary tract infection.” Ann Intern Med 117(2): 135–40.CrossRefGoogle ScholarPubMed
Lau, J., Ioannidis, J. P., et al. (2001a). “Diagnosing acute cardiac ischemia in the emergency department: a systematic review of the accuracy and clinical effect of current technologies.” Ann Emerg Med 37(5): 453–60.CrossRefGoogle ScholarPubMed
Lau, J., Ioannidis, J. P., et al. (2001b). Evaluation of Technologies for Identifying Acute Cardiac Ischemia in Emergency Departments. Rockville, MD, The Agency for Healthcare Research and Quality. Available at http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.37233.Google Scholar
Littenberg, B., and Moses, L. E. (1993). “Estimating diagnostic accuracy from multiple conflicting reports: a new meta-analytic method.” Med Decis Making 13(4): 313–21.CrossRefGoogle ScholarPubMed
Macaskill, P. (2004). “Empirical Bayes estimates generated in a hierarchical summary ROC analysis agreed closely with those of a full Bayesian analysis.” J Clin Epidemiol 57(9): 925–32.CrossRefGoogle Scholar
Mallett, S., Deeks, J. J., et al. (2006). “Systematic reviews of diagnostic tests in cancer: review of methods and reporting.” Br Med J 333(7565): 413.CrossRefGoogle ScholarPubMed
Mueller, C., Laule-Kilian, K., et al. (2006). “Cost-effectiveness of B-type natriuretic peptide testing in patients with acute dyspnea.” Arch Intern Med 166(10): 1081–7.CrossRefGoogle ScholarPubMed
Nassar, N., Roberts, C. L., et al. (2006). “Diagnostic accuracy of clinical examination for detection of non-cephalic presentation in late pregnancy: cross sectional analytic study.” Br Med J 333(7568): 578–80.CrossRefGoogle ScholarPubMed
Pai, M., McCulloch, M., et al. (2004). “Systematic reviews of diagnostic test evaluations: What's behind the scenes?” ACP J Club 141(1): A11–3.Google ScholarPubMed
Straus, S., Richardson, W., et al. (2005). Evidence-Based Medicine: How to Practice and Teach EBM. New York, Elsevier/Churchill Livingstone.Google Scholar
Wheeler, A. P., Bernard, G. R., et al. (2006). “Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury.” N Engl J Med 354(21): 2213–24.Google ScholarPubMed
Whiting, P., Harbord, R., et al. (2006). “Accuracy of magnetic resonance imaging for the diagnosis of multiple sclerosis: systematic review.” Br Med J 332(7546): 875–84.CrossRefGoogle Scholar
Eshed, I., Gorenstein, A., et al. (2004). “Intussusception in children: can we rely on screening sonography performed by junior residents?” Pediatr Radiol 34(2): 134–7.CrossRefGoogle ScholarPubMed
Maisel, A. S., Krishnaswamy, P., et al. (2002). “Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.” N Engl J Med 347(3): 161–7.CrossRefGoogle ScholarPubMed
Marill, K. A., Ingmire, T. E., et al. (1999). “Utility of a single beta HCG measurement to evaluate for absence of ectopic pregnancy.” J Emerg Med 17(3): 419–26.CrossRefGoogle ScholarPubMed
Schwam, E. (2004). “B-type natriuretic peptide for diagnosis of heart failure in emergency department patients: a critical appraisal.” Acad Emerg Med 11(6): 686–91.CrossRefGoogle ScholarPubMed
Werner, E. J., Abshire, T. C., et al. (1992). “Relative value of diagnostic studies for von Willebrand disease.” J Pediatr 121(1): 34–8.CrossRefGoogle ScholarPubMed
Bossuyt, P. M., Reitsma, J. B., et al. (2003). “Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.” Br Med J 326(7379): 41–4.CrossRefGoogle ScholarPubMed
Deeks, J. J. (2001). “Systematic reviews in health care: Systematic reviews of evaluations of diagnostic and screening tests.” Br Med J 323(7305): 157–62.CrossRefGoogle ScholarPubMed
Eshed, I., Gorenstein, A., et al. (2004). “Intussusception in children: can we rely on screening sonography performed by junior residents?” Pediatr Radiol 34(2): 134–7.CrossRefGoogle ScholarPubMed
Lachs, M. S., Nachamkin, I., et al. (1992). “Spectrum bias in the evaluation of diagnostic tests: lessons from the rapid dipstick test for urinary tract infection.” Ann Intern Med 117(2): 135–40.CrossRefGoogle ScholarPubMed
Lau, J., Ioannidis, J. P., et al. (2001a). “Diagnosing acute cardiac ischemia in the emergency department: a systematic review of the accuracy and clinical effect of current technologies.” Ann Emerg Med 37(5): 453–60.CrossRefGoogle ScholarPubMed
Lau, J., Ioannidis, J. P., et al. (2001b). Evaluation of Technologies for Identifying Acute Cardiac Ischemia in Emergency Departments. Rockville, MD, The Agency for Healthcare Research and Quality. Available at http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.37233.Google Scholar
Littenberg, B., and Moses, L. E. (1993). “Estimating diagnostic accuracy from multiple conflicting reports: a new meta-analytic method.” Med Decis Making 13(4): 313–21.CrossRefGoogle ScholarPubMed
Macaskill, P. (2004). “Empirical Bayes estimates generated in a hierarchical summary ROC analysis agreed closely with those of a full Bayesian analysis.” J Clin Epidemiol 57(9): 925–32.CrossRefGoogle Scholar
Mallett, S., Deeks, J. J., et al. (2006). “Systematic reviews of diagnostic tests in cancer: review of methods and reporting.” Br Med J 333(7565): 413.CrossRefGoogle ScholarPubMed
Mueller, C., Laule-Kilian, K., et al. (2006). “Cost-effectiveness of B-type natriuretic peptide testing in patients with acute dyspnea.” Arch Intern Med 166(10): 1081–7.CrossRefGoogle ScholarPubMed
Nassar, N., Roberts, C. L., et al. (2006). “Diagnostic accuracy of clinical examination for detection of non-cephalic presentation in late pregnancy: cross sectional analytic study.” Br Med J 333(7568): 578–80.CrossRefGoogle ScholarPubMed
Pai, M., McCulloch, M., et al. (2004). “Systematic reviews of diagnostic test evaluations: What's behind the scenes?” ACP J Club 141(1): A11–3.Google ScholarPubMed
Straus, S., Richardson, W., et al. (2005). Evidence-Based Medicine: How to Practice and Teach EBM. New York, Elsevier/Churchill Livingstone.Google Scholar
Wheeler, A. P., Bernard, G. R., et al. (2006). “Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury.” N Engl J Med 354(21): 2213–24.Google ScholarPubMed
Whiting, P., Harbord, R., et al. (2006). “Accuracy of magnetic resonance imaging for the diagnosis of multiple sclerosis: systematic review.” Br Med J 332(7546): 875–84.CrossRefGoogle Scholar

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