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Diagnosis Appraisal Tips

This document provides guidance on appraising articles about diagnostic tests. It outlines key factors to consider, including whether the study directly answers the clinical question, whether the reference standard was valid and independent of the index test, whether test interpretation was independent, and applicability of the results. Likelihood ratios should be examined as they indicate how much a test result changes the probability of disease. Finally, individualizing results to the specific patient based on pre-test probability and likelihood ratios is important.

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Sebastian Smythe
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49 views2 pages

Diagnosis Appraisal Tips

This document provides guidance on appraising articles about diagnostic tests. It outlines key factors to consider, including whether the study directly answers the clinical question, whether the reference standard was valid and independent of the index test, whether test interpretation was independent, and applicability of the results. Likelihood ratios should be examined as they indicate how much a test result changes the probability of disease. Finally, individualizing results to the specific patient based on pre-test probability and likelihood ratios is important.

Uploaded by

Sebastian Smythe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPRAISING AN ARTICLE ON DIAGNOSTIC TESTS

DIRECTNESS Why is it Important What to Look For


Does the study provide a direct Many times, the P, E and O are Seek the opinion of an expert
enough answer to your clinical not exactly the same as those (this might be you), or your
question in terms of patients studied by the authors of a colleagues.
(P), exposure (E) and outcome paper. If this is the case, you
(O)? In this situation the need to decide if you can use the
exposure is the test that is study results at all. The decision
being evaluated, and the requires some expertise on the
outcome is the disease being disease under question.
diagnosed
VALIDITY Why is it Important What to Look For

Was the reference standard an The reference standard should Look for how authors define
acceptable one? be one accepted by the scientific presence or absence of disease
community as the definition of in the study population.
disease. It is the yardstick with
which the performance of the test
is measured.
Was the “definition” of the index If multiple criteria were used as Look at the criteria used to
test and the reference standard reference standard, the index test interpret both reference and index
independent? should not be part of the criteria text and make sure they don’t
as this will lead to a high level of overlap.
agreement between the two.
Was the “performance” of the If the reference standard was Look for measures taken to
index test and the reference done because of a result of the ensure that the result of the index
standard independent? index test, then the index test will test did not influence doing the
look better than it actually is. reference standard.
Was the “interpretation” of the Knowledge of the results of an Look for measures to ensure that
index test and the reference index test may influence the the interpretation of the index test
standard independent? interpretation of results of the result did not affect the
reference standard. interpretation of the reference
standard.
RESULTS Why is it Important What to Look For
What were the likelihood ratios Likelihood ratios tell us by how Look for likelihood ratios. If these
of the various test results? much the likelihood of disease are not reported, they can be
changes, given a test result. It is derived from sensitivity and
a measure of how useful a test is. specificity.

APPLICABILITY Why is it Important What to Look For


Are there biologic issues that Sometimes, these variables may Prior knowledge and experience
may affect applicability of the affect how well the test performs with the disease will be useful.
estimates of test accuracy? in various populations.
(Consider the influence of sex,
co-morbidity, race, age and
pathology)

Dx Appraisal Tips 2017


Are there socio-economic Social, cultural and economic Prior knowledge and experience
issues that may affect context may potentially affect with the disease will be useful.
applicability of the estimates of diagnostic test performance.
test accuracy?

Appraising an Article on Diagnostic Tests_p.2

INDIVIDUALIZING RESULTS Why it is important What to look for


How might the test results Studies report average effects but Using the patient’s pre-test
affect the probability of disease the effect on your patient may not probability (based on clinical
in your individual patient? be average, presentation) and the likelihood
ratio (based on the study), one
can estimate the patient-specific
post-test probability.

Dx Appraisal Tips 2017

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