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Value of composite reference standards in diagnostic research
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Combining several tests is a common way to improve the final classification of disease status in diagnostic accuracy studies but is often used ambiguously. This article gives advice on proper use and reporting of composite reference standards
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“However, because of the uncertainties that surround a clinical diagnosis of tuberculosis and, in some instances, the conditional dependence of the index tests and other tests in the composite reference standard (for example, for most of these tests, detection of tuberculosis depends on bacillary load), a reference standard that uses additional tests and clinical characteristics (in culture‐”
From Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults (2021) · cites this paper as Naaktgeboren 2013
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“In diagnostic accuracy studies, an imperfect reference standard may lead to a misclassification of samples [33,34].”
From Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis (2014) · cites this paper as [34]
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“We also considered the possibility that the reference standard could introduce bias due to misclassification of participants (fig.2) [34,35].”
From Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis (2014) · cites this paper as [34]
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Metadata
- Authors
- Naaktgeboren, C. A., Bertens, L. C. M., Smeden, M. V., Groot, J. A. H. D., Moons, K. G. M., & Reitsma, J. B.
- Affiliations
- University Medical Center Utrecht (NL)
- Corresponding author
- Naaktgeboren, C. A.
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2013-10-25
- Volume
- 347
- Issue
- oct25 2
- Pages
- f5605-f5605
- ISSN
- 1756-1833 (ISSN-L)
- OpenAlex
- W2025991594
- Semantic Scholar
- 8a21543e4ffabd1aacc8c2181000b9b6fafc626e
- Cited by
- 105
- References
- 27
- Citations by year
- 2026: 9 · 2025: 5 · 2024: 6 · 2023: 7 · 2022: 8 · 2021: 13 · 2020: 6 · 2019: 13 · 2018: 11 · 2017: 7 · 2016: 6 · 2015: 10 · 2014: 4
- FWCI
- 7.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
- Keywords
- composite reference standard, diagnostic accuracy, disease classification, test combination, reporting guidelines
- MeSH terms
- Diagnostic Errors, Reference Standards, Research Design, Diagnostic Techniques and Procedures, Research Report
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