Diagnostic test accuracy

Campbell, Jared M.; Klugar, Miloslav; Ding, Sandrine; Carmody, Dennis P.; Håkonsen, Sasja Jul; Jadotte, Yuri T.; White, Sarahlouise; Munn, Zachary

doi:10.1097/xeb.0000000000000061

Cited by 105 publications

(47 citation statements)

References 19 publications

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“…One statistical complication is that accuracy is typically summarised using two linked, dependent outcomes: sensitivity (the accuracy of the test in patients with the target condition) and specificity (the accuracy of the test in patients without the target condition) [6]. Statistical models which account for these correlated outcomes, such as the bivariate model and the Hierarchical Summary Receiver Operating Characteristic (HSROC) model, are now advocated as best practice [5, 7–9]. …”

Section: Introductionmentioning

confidence: 99%

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological review of health technology assessments

Shinkins

Yang

Abel

et al. 2017

BMC Med Res Methodol

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BackgroundEvaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy.MethodsWe assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated.ResultsThe bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings.ConclusionsThe uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-017-0331-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological review of health technology assessments

Shinkins

Yang

Abel

et al. 2017

BMC Med Res Methodol

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“…(Pearson, 2004). Questions concerning assessment and/or diagnostic accuracy may use a modified PICO format to include details of the assessments/tests under examination (Campbell et al, 2015;White, Schultz, & Enuameh, 2011).…”

Section: A Well-built Clinical Questionmentioning

confidence: 99%

Letting the CAT out of the bag: Contribution of critically appraised topics to evidence-based practice

White

Raghavendra

McAllister

2017

Evidence-Based Communication Assessment and Intervention

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Locating the best available research, critically appraising it and synthesizing the findings with evidence from practice and the wishes of the service user and/or their advocate(s) is central to providing high-quality services to people with communication impairments. Determining whether research evidence is high quality, recent, and relevant is a particular challenge for practitioners. Knowledge translation strategies such as providing critical appraisals of research and advice on how to apply the findings provide useful support to the decision-making process. There are a number of formats that provide critical appraisals of research, the most familiar being systematic reviews, critically appraised papers, and rapid reviews. A critically appraised topic (CAT) is one form of rapid review that can be particularly useful for informing practice in a rich and nuanced manner. We will discuss the features of CATs along with similarities and differences to systematic reviews, critically appraised papers, and other types of rapid reviews. Additionally, we will provide guidance on how to conduct a CAT, present the information, and use it to support high-quality communication assessment and intervention practice.

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“…Por se tratar de um teste aplicado na triagem de pacientes, o SMCR deve apresentar uma alta sensibilidade, sem no entanto, comprometer a especificidade, que é também um fator determinante para a segurança dos pacientes, pois está diretamente relacionada com a ocorrência de "overtriage" e, portanto, com a possibilidade de retardo no atendimento de pacientes mais graves (38,39) .…”

Section: Sensibilidade E Especificidade Do Smcrunclassified

“…Esta divergência está diretamente relacionada à diferença dos critérios de inclusão dos participantes dos dois estudos (39) . Uma especificidade de 0,59 foi reportada no estudo que incluiu somente pacientes que apresentavam queixa de dor torácica sem história de trauma (50) , indicando que nesse cenário 59% dos pacientes que não tinham diagnóstico de SCA foram classificados como amarelo, verde ou azul.…”

Section: Análise E Síntese Dos Dadosunclassified

“…Tendo em vista as características do SMCR e sua aplicação, ao realizar uma avaliação desse sistema é fundamental observar os valores preditivos e ainda a proporção de pacientes corretamente classificados em relação ao diagnóstico de SCA (39) . Assim, um resultado negativo do Manchester nesses estudos reduziu a probabilidade de SCA de 0,58% para 0,20% e de 9,40% para 3,80% respectivamente (52) .…”

Section: Valores Preditivos E Razão De Verossimilhançaunclassified

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Sensibilidade e especificidade do Sistema Manchester de Classificação de Risco na priorização de pacientes com infarto agudo do miocárdio que apresentam dor torácica

Nishi

Polak

Cruz

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Diagnostic test accuracy

Cited by 105 publications

References 19 publications

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological review of health technology assessments

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological review of health technology assessments

Letting the CAT out of the bag: Contribution of critically appraised topics to evidence-based practice

Sensibilidade e especificidade do Sistema Manchester de Classificação de Risco na priorização de pacientes com infarto agudo do miocárdio que apresentam dor torácica

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