Intended for healthcare professionals


Retrospective analysis of evidence base for tests used in diagnosis and monitoring of disease in respiratory medicine

BMJ 2003; 327 doi: (Published 13 November 2003) Cite this as: BMJ 2003;327:1136
  1. Z Borrill, clinical fellow1,
  2. C Houghton, clinical fellow1,
  3. P J Sullivan, consultant (Paul.sullivan{at},
  4. P Sestini, associate professor of respiratory diseases2
  1. 1Department of Cardiorespiratory Medicine, Hope Hospital, Manchester M6 8HD
  2. 2Department of Clinical Medicine and Immunological Sciences, Division of Respiratory Diseases, University of Siena, Viale Bracci 3, 53100 Siena, Italy
  1. Correspondence to: P J Sullivan
  • Accepted 4 September 2003


Objectives To determine how many common clinical tests used in a respiratory medicine outpatient clinic are based on high quality evidence.

Design Retrospective review of case notes. Record of first three tests for each patient. Diagnostic tests, tests used to assess existing condition, explicit trials of therapy were included. Literature search for supporting evidence and grading of best evidence for each test.

Setting Inner city university teaching hospital in the United Kingdom.

Participants All new outpatients referred to a single respiratory medicine team over a period of three months.

Main outcome measures Proportion of tests supported by level 1a-1c evidence (scale developed by Centre for Evidence Based Medicine).

Results Only half the tests that were used to make or exclude a diagnosis and a fifth of the tests used to assess a known condition were supported by level 1a-1c evidence. There was no evidence to support trials of therapy.

Conclusions A large proportion of clinical tests in respiratory medicine are not supported by level 1a-1c evidence. None of the therapeutic trials that were used were supported by evidence.


  • Contributors : PS had the original idea for the study. PJS and PS designed the study. PJS and ZB surveyed case notes, performed literature searches, and graded evidence. CH surveyed case notes. All authors commented on drafts. PJS is guarantor and can provide further details of the evidence found

  • Funding None.

  • Conflict of interest None.

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