Patient outcomes and population context affect test accuracy

doi:10.1136/bmj.326.7389.601/a

BMJ 2003;326:601 ( 15 March )

Letters

Patient outcomes and population context affect test accuracy

The first 150 words of the full text of this article appear below.

EDITOR $---$ Publication of the STARD paper, on standards for reporting of studies of diagnostic accuracy, should ensure increasedattention to the problems of poor diagnostic research.¹ Increasedawareness of reporting of accuracy studies should lead to betterstudy designs and hence improve the evidence base for diagnostictests.

However, accuracy is but one aspect of assessing diagnostic tests. Other evidence is required for determining the clinicalutility of a test $---$ reproducibility, effectiveness, and cost effectiveness.A test is not robust if not reproducible, yet evidence is oftenlacking. The effect of test accuracy on patients' outcomes iscrucial, but the size of effect and the optimum balance betweensensitivity and specificity depends on the context in which thetest isused.

Decisions about patient management may be based on one test alone, as in a screening test, or be part of a battery of tests.For a screening test, . . . [Full text of this article]

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