Chapter 7: grading a body of evidence on diagnostic tests.
Abstract
<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.
Type
Journal articleSubject
HumansDiagnostic Techniques and Procedures
Evidence-Based Medicine
Publication Bias
Review Literature as Topic
Guidelines as Topic
Outcome and Process Assessment, Health Care
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https://hdl.handle.net/10161/22832Published Version (Please cite this version)
10.1007/s11606-012-2021-9Publication Info
Singh, 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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
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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