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Multivariable adjustments counteract spectrum and test review bias in accuracy studies.

Abstract：

OBJECTIVES:The STAndards for Reporting studies of Diagnostic accuracy (STARD) for investigators and editors and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) for reviewers and readers offer guidelines for the quality and reporting of test accuracy studies. These guidelines address and propose some solutions to two major threats to validity: spectrum bias and test review bias. STUDY DESIGN AND SETTING:Using a clinical example, we demonstrate that these solutions fail and propose an alternative solution that concomitantly addresses both sources of bias. We also derive formulas that prove the generality of our arguments. RESULTS:A logical extension of our ideas is to extend STARD item 23 by adding a requirement for multivariable statistical adjustment using information collected in QUADAS items 1, 2, and 12 and STARD items 3-5, 11, 15, and 18. CONCLUSION:We recommend reporting not only variation of diagnostic accuracy across subgroups (STARD item 23) but also the effects of the multivariable adjustments on test performance. We also suggest that the QUADAS be supplemented by an item addressing the appropriateness of statistical methods, in particular whether multivariable adjustments have been included in the analysis.

journal_name

J Clin Epidemiol

journal_title

Journal of clinical epidemiology

authors

Bachmann LM,ter Riet G,Weber WE,Kessels AG

doi

10.1016/j.jclinepi.2008.02.007

subject

Has Abstract

pub_date

2009-04-01 00:00:00

pages

357-361.e2

issue

4

eissn

0895-4356

issn

1878-5921

pii

S0895-4356(08)00056-5

journal_volume

62

pub_type

杂志文章

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