Evidence based diagnostics

doi:10.1136/bmj.330.7493.724

BMJ 2005;330:724-726 (26 March), doi:10.1136/bmj.330.7493.724

Education and debate

Evidence based diagnostics

Christian Gluud, head of department¹, Lise Lotte Gluud, specialist registrar¹

¹ Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, H:S Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark

Correspondence to: C Gluud cgluud@ctu.rh.dk

Diagnostic tests are often much less rigorously evaluated thannew drugs. It is time to ensure that the harms and benefitsof new tests are fully understood

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

Introduction

No international consensus exists on the methods for assessingdiagnostic tests. Previous recommendations stress that studiesof diagnostic tests should match the type of diagnostic question.^1
2Once the specificity and sensitivity of a test have been established,the final question is whether tested patients fare better thansimilar untested patients. This usually requires a randomisedtrial. Few tests are currently evaluated in this way. In thispaper, we propose an architecture for research into diagnostictests that parallels the established phases in drug research.

Stages of research

We have divided studies of diagnostic tests into four phases(box). We use research on brain natriuretic peptide for diagnosingheart failure as an illustrative example.² However, the architectureis applicable to a wide range of tests including laboratorytechniques, diagnostic imaging, pathology, evaluation of disability,electrodiagnostic tests, and endoscopy.

Establishing the normal range

In drug research, phase I studies deal with pharmacokinetics,pharmacodynamics, and safe doses.³ Phase I diagnostic . . . [Full text of this article]

Diagnostic accuracy

Clinical effects

Long term consequences

Conclusion

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Articles

Licensing diagnostic tests may benefit everyone: Eric S Kilpatrick
BMJ 2005 330: 1330. [Extract] [Full Text]

New diagnostic tests need more rigorous evaluation
BMJ 2005 330: 0. [Full Text]

Heading where exactly?: Fiona Godlee
BMJ 2005 330: 0. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Fens, N., Zwinderman, A. H., van der Schee, M. P., de Nijs, S. B., Dijkers, E., Roldaan, A. C., Cheung, D., Bel, E. H., Sterk, P. J. (2009). Exhaled Breath Profiling Enables Discrimination of Chronic Obstructive Pulmonary Disease and Asthma. Am. J. Respir. Crit. Care Med. 180: 1076-1082 [Abstract] [Full text]
Heesen, C, Schaffler, N, Kasper, J, Muhlhauser, I, Kopke, S (2009). Suspected multiple sclerosis - what to do? Evaluation of a patient information leaflet. Mult Scler 15: 1103-1112 [Abstract]
Meyer, G., Kopke, S., Haastert, B., Muhlhauser, I. (2009). Comparison of a fall risk assessment tool with nurses' judgement alone: a cluster-randomised controlled trial. Age Ageing 38: 417-423 [Abstract] [Full text]
Lefievre, L., Bedu-Addo, K., Conner, S. J, Machado-Oliveira, G. S M, Chen, Y., Kirkman-Brown, J. C, Afnan, M. A, Publicover, S. J, Ford, W C. L, Barratt, C. L R (2007). Counting sperm does not add up any more: time for a new equation?. Reproduction 133: 675-684 [Abstract] [Full text]
Harbord, R. M., Deeks, J. J., Egger, M., Whiting, P., Sterne, J. A. C. (2007). A unification of models for meta-analysis of diagnostic accuracy studies. Biostatistics 8: 239-251 [Abstract] [Full text]
van Zaane, B., Nierich, A. P., Buhre, W. F., Brandon Bravo Bruinsma, G. J., Moons, K. G. M. (2007). Resolving the blind spot of transoesophageal echocardiography: a new diagnostic device for visualizing the ascending aorta in cardiac surgery. Br J Anaesth 98: 434-441 [Abstract] [Full text]
Sanchini, M. A., Nanni, O., Calistri, D. (2006). Urine Telomerase and Bladder Cancer Detection--Reply. JAMA 295: 999-999 [Full text]
Kilpatrick, E. S (2005). Licensing diagnostic tests may benefit everyone. BMJ 330: 1330-1330 [Full text]

Rapid Responses:

Read all Rapid Responses

Analytical problems (not only) with BNP determining: Rudolf Gasko
bmj.com, 26 Mar 2005 [Full text]
Licensing diagnostic tests may benefit everyone: Eric S Kilpatrick
bmj.com, 26 Mar 2005 [Full text]
Use established methods for evaluating diagnostic methods: Sten �hman
bmj.com, 29 Mar 2005 [Full text]
Multivariable approaches should not be left out in evidence based diagnostics: Gerben ter Riet, et al.
bmj.com, 4 Apr 2005 [Full text]
Diagnostics is a sea: it�s time to navigate into it: Giuseppe Giocoli
bmj.com, 1 Apr 2005 [Full text]
Evidence based diagnostics: what about customary clinical tests: Alireza Moayyeri, et al.
bmj.com, 11 Apr 2005 [Full text]
Evidence based diagnostics and genetic testing: Simon P Sanderson, et al.
bmj.com, 15 Apr 2005 [Full text]
Authors' reply: Christian Gluud, et al.
bmj.com, 24 May 2005 [Full text]
Cost-effectiveness should be included in diagnostic research: Joanna D Schaafsma, et al.
bmj.com, 3 Jun 2005 [Full text]