APPRAISING AN ARTICLE ON DIAGNOSTICS
General Objective:
To apply the various rules of evidence in deciding if the results of an article on a diagnostic test are valid.
Specific Objectives:
1. To discuss the rationale for each of the user’s guide pertaining to the validity of claims on accuracy.
2. To define and differentiate the concepts of validity and precision, as they pertain to the results of a diagnostic test.
3. To learn the definitions of and calculations for sensitivity, specificity, positive predictive value, negative predictive
value, likelihood ratio, pre-test probability, post-test probability, pre-test odds, and post-test odds.
4. To recognize the advantages and disadvantages of using likelihood ratios, sensitivities and specificities, and predictive
values in measuring the accuracy of a diagnostic test.
5. To learn how to estimate post-test probabilities given a pre-test probability and a measure of accuracy (a likelihood
ratio or a sensitivity and specificity).
Short Programme
I. Small group discussion with facilitator (45 minutes)
II. Presentation of CAT appraisal (7 minutes per group)
Clinical Scenario
JJ, a 26-year-old male, came into your clinic to seek consult. He is a manager at a call center. Two days ago, one of his
employees presented with cough and colds at one of their hour-long meetings. Unfortunately, that employee tested
positive for SARS-Cov2 infection. As per their company protocol, all persons exposed to a confirmed case shall
undergo oronasal COVID19 testing, but at their own expense.
JJ, who has colds, comes into the clinic with a RAT Standard Q COVID-19 Ag test (SD Biosensor, Inc., Republic of
Korea). His Korean neighbor gave him the testing kit. However, he is unsure about the test’s diagnostic accuracy.
General Instruction
Each small group will solve the clinical scenario (see Appraisal Form). Each learner in a small group will be required to submit
an accomplished Appraisal Form at the end of every activity.
APPRAISAL FORM FOR DIAGNOSTICS
Resident Name ________________________________ YL _____ Date ____________
Journal Title:
___________________________________________________________________________________
Identify P,E,O, M Clinical Question
P = patient with colds
E = RAT Standard Q COVID-19 Ag test vs RT-PCR
O = diagnosis of SARS-CoV2 infection
M = RCT
Search terms used in PubMed Hits
1
2
3.
I. APPRAISING DIRECTNESS
Does the study provide a direct
enough answer to your clinical
question in terms of patients (P),
examination (E) used and disease or
outcome (O) being diagnosed?
II. APPRAISING VALIDITY
1. Was the reference standard an
acceptable one?
2. Was “definition” of the index test and
the reference standard independent?
3. Was “performance” of the index test
and the reference standard
independent?
4. Was “interpretation” of the index test
and the reference standard
independent?
III. APPRAISING RESULTS
1. What were the likelihood ratios of the
various test results?
IV. ASSESSING APPLICABILITY:
1. Are there biologic issues that may
affect applicability of treatment?
(Consider the influence of sex, co-
morbidity, race, age and pathology)
2. Are there socio-economic issues
affecting applicability of treatment?
Reviewer’s Conclusions
Author’s Conclusions
V. INDIVIDUALIZING THE RESULTS:
1. How will the test results affect the
probability of disease in your patient?
(Estimate the individualized post-test
probability of your patient)
2. Is this test useful for your patient?
