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Cited by 524Meta-analysis and systematic reviewsStatistical Methods in EpidemiologyReliability and Agreement in Measurement

The DOI matches its Crossref record; 175 of the 175 references it cites were found in a registry or an index.

Evaluation of diagnostic tests when there is no gold standard. A review of methods

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Rutjes, A, Reitsma, J, Coomarasamy, A, Khan, K, Bossuyt, P·2007·Health Technology Assessment
DOI 10.3310/hta11500
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Abstract

OBJECTIVE: To generate a classification of methods to evaluate medical tests when there is no gold standard. METHODS: Multiple search strategies were employed to obtain an overview of the different methods described in the literature, including searches of electronic databases, contacting experts for papers in personal archives, exploring databases from previous methodological projects and cross-checking of reference lists of useful papers already identified. RESULTS: All methods available were classified into four main groups. The first method group, impute or adjust for missing data on reference standard, needs careful attention to the pattern and fraction of missing values. The second group, correct imperfect reference standard, can be useful if there is reliable information about the degree of imperfection of the reference standard and about the correlation of the errors between the index test and the reference standard. The third group of methods, construct reference standard, have in common that they combine multiple test results to construct a reference standard outcome including deterministic predefined rules, consensus procedures and statistical modelling (latent class analysis). In the final group, validate index test results, the diagnostic test accuracy paradigm is abandoned and research examines, using a number of different methods, whether the results of an index test are meaningful in practice, for example by relating index test results to relevant other clinical characteristics and future clinical events. CONCLUSIONS: The majority of methods try to impute, adjust or construct a reference standard in an effort to obtain the familiar diagnostic accuracy statistics, such as sensitivity and specificity. In situations that deviate only marginally from the classical diagnostic accuracy paradigm, these are valuable methods. However, in situations where an acceptable reference standard does not exist, applying the concept of clinical test validation can provide a significant methodological advance. All methods summarised in this report need further development. Some methods, such as the construction of a reference standard using panel consensus methods and validation of tests outwith the accuracy paradigm, are particularly promising but are lacking in methodological research. These methods deserve particular attention in future research.

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Metadata

Authors
Rutjes, A., Reitsma, J., Coomarasamy, A., Khan, K., & Bossuyt, P.
Affiliations
  • Amsterdam UMC Location University of Amsterdam (NL)
  • University of Birmingham (GB)
ORCID
Venue
Health Technology Assessment
Publisher
National Institute for Health and Care Research
Published
2007-12
Volume
11
Issue
50
Pages
iii, ix-51
ISSN
  • 1366-5278 (ISSN-L)
  • 2046-4924
DOI
10.3310/hta11500
OpenAlex
W2143712591
Cited by
524
References
175
Citations by year
2026: 21 · 2025: 21 · 2024: 20 · 2023: 23 · 2022: 36 · 2021: 34 · 2020: 39 · 2019: 38 · 2018: 57 · 2017: 31 · 2016: 33 · 2015: 27 · 2014: 29 · 2013: 27 · 2012: 30
FWCI
2.43
Type
journal article
Language
en
Open access
Licence
Locations
  • Health Technology Assessment (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders
Health Technology Assessment programme (06/90/23)
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
diagnostic accuracy, absence of gold standard, reference materials, imperfect reference standard, latent class analysis, sensitivity and specificity, methodological review
MeSH terms
Humans, Reference Standards, Sensitivity and Specificity, Process Assessment, Health Care, Diagnostic Techniques and Procedures

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