Chapter 7: grading a body of evidence on diagnostic tests.
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<h4>Introduction</h4>Grading the strength of a body of diagnostic test evidence involves challenges over and above those related to grading the evidence from health care intervention studies. This chapter identifies challenges and outlines principles for grading the body of evidence related to diagnostic test performance.<h4>Challenges</h4>Diagnostic test evidence is challenging to grade because standard tools for grading evidence were designed for questions about treatment rather than diagnostic testing; and the clinical usefulness of a diagnostic test depends on multiple links in a chain of evidence connecting the performance of a test to changes in clinical outcomes.<h4>Principles</h4>Reviewers grading the strength of a body of evidence on diagnostic tests should consider the principle domains of risk of bias, directness, consistency, and precision, as well as publication bias, dose response association, plausible unmeasured confounders that would decrease an effect, and strength of association, similar to what is done to grade evidence on treatment interventions. Given that most evidence regarding the clinical value of diagnostic tests is indirect, an analytic framework must be developed to clarify the key questions, and strength of evidence for each link in that framework should be graded separately. However if reviewers choose to combine domains into a single grade of evidence, they should explain their rationale for a particular summary grade and the relevant domains that were weighed in assigning the summary grade.
Diagnostic Techniques and Procedures
Review Literature as Topic
Guidelines as Topic
Outcome and Process Assessment, Health Care
Published Version (Please cite this version)10.1007/s11606-012-2021-9
Publication InfoSingh, Sonal; Chang, Stephanie M; Matchar, David B; & Bass, Eric B (2012). Chapter 7: grading a body of evidence on diagnostic tests. Journal of general internal medicine, 27 Suppl 1(SUPPL.1). pp. S47-S55. 10.1007/s11606-012-2021-9. Retrieved from https://hdl.handle.net/10161/22832.
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David Bruce Matchar
Professor of Medicine
My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention. Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analy
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