抽象
Until we have better reference tests for PCD, diagnostic accuracy cannot be meaningfully evaluated or claimedhttp:///wly/4n6vri.
To the Editor:
英国南安普敦的主要睫状体动态(PCD)组,由J.S.领导。为了提高PCD诊断的准确性,卢卡斯将被鼓掌。在最近的两篇文章中由本集团发表European Respiratory Journal[1,2[分析了大量PCD推荐案例,并绘制了关于诊断准确性的各种结论,以及推导的临床预测规则,建议有助于进一步推荐和调查PCD。
The major problem with these data, however, is that the authors have not essentially evaluated diagnostic accuracy. In diagnostic accuracy studies, the ability of one or more tests to correctly identify patients with the target condition is typically expressed as the sensitivity and specificity of the test(s). These are estimated by comparing the test results to the results of the reference standard, the best available method for correctly identifying patients with the target condition.
诊断准确性研究可能面临偏置的风险,已经描述了几个偏差源[3,4]。由于设计缺陷而有偏见风险的研究通常高估测试性能指标,但也限制了研究结果的适用性。
Unfortunately, these recent PCD studies are not at low risk of bias. The authors did not notify the readers of two design deficiencies. The first is that the diagnostic criteria in the study by JACKSON.et al.[2] (the reference criteria) include the index tests measured. This was also done in the prediction rule study [1]。所得到的偏差被称为掺入偏差,并且已知导致对测试性能的准确性和慷慨结论的估计。
Furthermore, the calculated estimates of specificity and sensitivity were based on the number of participants who were diagnosed as PCD (or not) by the reference criteria. However, as no gold standard exists in PCD, exclusion of the disease (true negative) is almost impossible to achieve in that situation. This is exemplified in genetic tests, where a negative finding of a PCD-causing mutation does not necessarily confirm that the patient has no PCD, as only 60–70% of the mutations are known.
We feel that the best (and probably only) diagnostic performance indicator that can be meaningfully discussed in these studies is the positive predictive value of the various tests. To associate these tests with the conventional accuracy statistics, sensitivity and specificity, we still need to wait, as indeed suggested (for other reasons) by Haarman和schmidts[5]在他们的一篇论文中的社论中。直到我们有一些优于当前青铜或银标的参考测试,直到目前的青铜或银标量优于,无法有意义地评估或要求保护诊断准确性。
脚注
Conflict of interest: None declared.
- 收到2016年4月1日。
- AcceptedApril 11, 2016.
- 版权所有©2016