Evaluating Medical Tests Objective and Quantitative Guidelines

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ISBN: 9780803946125 | 0803946120
Cover: Paperback
Copyright: 3/23/1992

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In this book, Kraemer presents a systematic, objective methodology by which to determine the effectiveness of medical tests. She shows clearly and concisely how to define statistical terms and approaches consistently from study to study, how to stipulate statistical assumptions underlying various approaches, how to check for empirical validity and how to judge the robustness of statistical outcomes, resulting in models that integrate many different approaches and extend the strengths of each.

List of Statistical Notations: Commonly Used Names and Symbols

Foreword

A. John Rush

Preface

Acknowledgments

xxi

Introduction

(4)

Disorder and Diagnosis

(13)

The Disorder

(1)

The Diagnosis of the Disorder

(2)

Diagnostic and Prognostic Tests

(1)

The Basic Model

(5)

The Prevalence and Reproducibility of the Diagnosis

(1)

High- and Low-Risk Populations

(1)

Pre- and Posttest Risk, Prevalence, and Incidence: Confusing Terms

(1)

Summary

(1)

Definition: Test Protocol, Response, Referent

(5)

The Basic Model

(1)

Summary

(2)

Families of Test Referents

(3)

Definitions: Base and Family

(2)

A Special Family: Multiple Discriminant Rules

(1)

Summary

(1)

Population and Sampling

(37)

Outcomes: True and False Positives and Negatives

(2)

Blind Evaluation

(1)

The Basic Model

(4)

Descriptors of Outcomes: Sensitivity, Specificity, Predictive Values, and Efficiency

(1)

Naturalistic Sampling

(6)

The Two-by-Two Chi-Square Test

(4)

Retrospective Sampling

(5)

The Problem of Dropouts

(4)

Prospective Sampling

(4)

The Sampling Unit

(1)

Pseudo-Retrospective Sampling: An Invalid Approach

(3)

Summary

(2)

Sensitivity and Specificity: The Signal Detection Approach

(33)

Problems with Sensitivity and Specificity

(2)

The Basic Model

(6)

The Receiver Operating Characteristic Curve (Test ROC)

(4)

The Quality Receiver Operating Characteristic Curve (QROC)

(2)

All Q-Level Tests

(5)

What Is a Good Test? The Diagnosis ROC, QROC

(4)

What Is the Ideal Test? The Disorder ROC, QROC

(5)

Thc Myth of the Constancy of Sensitivity and Specificity

(3)

Summary

(2)

Predictive Values: The Bayesian Approach, Risk Ratios, and Odds Ratio

(18)

Problems with Predictive Values

(2)

The Basic Model

(2)

A Geometric Approach: The Test QROC

100

(3)

Risk Ratios, Odds Ratio, and the Test QROC

103

(10)

Summary

113

(1)

Efficiency: Choosing Clinically Optimal Tests

114

(17)

The Problem with Efficiency

114

(1)

The Basic Model

115

(4)

Consideration of Medical Consequences of Errors: The Weighted Kappa Coefficient

119

(4)

A Geometric Approach: The Test QROC

123

(6)

Summary

129

(2)

Taking Test Costs into Account: Costworthy Tests

131

(24)

Introduction

131

(4)

The Basic Model

135

(10)

Derivation of the Quality Index k(r,t)

135

(3)

The Benefit Threshold of a Medical Test

138

(2)

Full Evaluation of a Test Family

140

(5)

A Geometric Approach: The QCROC

145

(4)

The Costs and Risks of Too Much Information

149

(2)

Informed Consent for Medical Tests

151

(2)

Summary

153

(2)

Basic Issues in Using Multiple Tests

155

(10)

Introduction

155

(1)

Tests in Parallel or Tests in Sequence

156

(5)

The Quality of Combined Tests

161

(2)

When Should a Test Be Repeated?

163

(1)

Should a Test Be Done Blind to Previous Test Results?

163

(1)

Summary

164

(1)

Evaluating Batteries of Medical Tests: Optimal Sequences

165

(34)

Introduction

165

(1)

The Basic Model

166

(4)

Compiling the Raw Data Base

170

(6)

Compiling the Working Data Base

176

(3)

Selection of the Optimal First Test and Reiteration

179

(1)

Increasing the Yield

180

(5)

Testing the Quality Index Using a Statistical Jackknife

185

(2)

Completing the Search for the Optimal Battery Structure

187

(1)

The Final Recommendation for Battery Structure

188

(5)

An Alternative Strategy

193

(1)

Summary

194

(5)

Evaluating Batteries of Medical Tests: Optimal Scores

199

(29)

Introduction

199

(5)

The Basic Model

204

(5)

Multiple Linear Discrimination

209

(7)

Logistic Regression Analysis

216

(6)

Some Practical Considerations in Choosing and Using Models

222

(5)

Summary

227

(1)

Evaluating Batteries of Prognostic Tests with Variable Follow up Times

228

(38)

Introduction

228

(3)

The Basic Model

231

(3)

Ignoring the Problem of Variable Follow-up: A Possibly Invalid Approach

234

(1)

Counting Time and Not Patients: Another Possibly Invalid Procedure

234

(5)

Tailoring the Data to Fit the Solution: An Invalid and Inefficient Approach

239

(2)

Estimating Survival Curves with Variable Follow-up Times: The Kaplan-Meier Method

241

(6)

Some General Observations on the Choice of Follow-up Time and Its Impact on Test Evaluation

247

(3)

Evaluating a Family of Prognostic Tests with a Variable Follow-up Time

250

(6)

An Alternative? Randomized Clinical Trials for the Evaluation of Screening Programs (Test + Intervention) for Prevention

256

(3)

Evaluating a Battery of Prognostic Tests with Variable Follow-up Periods: Sequential Structuring

259

(1)

Evaluating a Battery of Prognostic Tests Using Variable Follow-up: Scoring a Battery with the Proportional Hazards Model

259

(4)

Summary

263

(3)

Evaluation of Medical Tests: The Past, Present, and Future

266

(20)

Introduction: The Past and the Present

266

(6)

The Future: Unsolved Problems

272

(4)

Problem: Evaluation of Monitoring Tests

272

(1)

Problem: Multicategory Responses

273

(1)

Problem: Stopping Rules

274

(1)

Other Pro6lems

275

(1)

The Present: An Overall Summary

276

(10)

What Is the Disorder? What Diagnosis Is to Be Used? Is the Diagnosis Clinically Valid and Reliable?

276

(1)

In What Clinical Population or Populations Is the Test Proposed for Use? How Can the Sampling Be Done so as to Obtain a Representative Sample from That Population or Populations?

277

(1)

If the Test Is to Be Evaluated as a Prognostic Test, Will the Follow-up Be Fixed or Variable? If the Follow-up Is to Be Fixed, Fixed at What Time?

277

(1)

Will Sampling Be Naturalistic, Retrospective, or Prospective?

277

(1)

How Large a Sample Is Needed?

278

(1)

How Are Dropouts and Missing Responses Avoided?

278

(1)

What Are the Clinical Benefits in this Situation?

279

(1)

What Are the Tests under Evaluation--Their Protocols, Responses, and Referents? What Are the Test Costs? If This is a Single Test (a Single Fixed Cost for All the Responses) or Is This to Be Considered a Battery of Tests (Separable Costs)?

279

(1)

How Are the Blinding of the Diagnosis and Test Results Assured? If There Are Multiple Tests in a Battery under Evaluation, Are These Blinded to Each Other?

280

(1)

Is There any Internal or External Standard Provided for the Performance of an Excellent Test?

280

(1)

Was the Data Base Properly Compiled and Thoroughly Checked for Errors?

281

(1)

For Each Single Test under Evaluation, for Each Test in the Battery Under Evaluation, and for Each Population Under Evaluation, Have the Descriptive Statistics Been Properly Computed?

282

(1)

What Is the Quality of Each Single Test Under Evaluation, and for Each Population Under Evaluation (and in an Evaluation of a Prognostic Test with Variable Follow-up Time, for Each Possible Value of Follow-up Time)?

282

(2)

Has the Optimal Referent for a Test, or the Optimal First Test in a Battery of Tests Been Appropriately Selected?

284

(1)

If There Is a Battery of Tests Under Consideration, Has the Battery Been Appropriately Evaluated?

285

(1)

References

286

(5)

Index

291

(4)

About the Author

295

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