| Автор | Midgette, Andre, S. |
| Автор | Stukel, Therese, A. |
| Автор | Littenberg, Benjamin |
| Дата выпуска | 1993 |
| dc.description | The authors have devised a meta-analytic method to summarize diagnostic test perfor mances, which they describe along with a clinical example wherein they analyze the perfor mances of real-time ultrasonography in eight studies of the detection of proximal deep venous thrombosis of the lower extremity, selected on the basis of specific inclusion criteria. To evaluate the evidence for fitting a summary receiver operating characteristic (ROC) curve, a test of correlation between the estimates of true-positive rate (TPR) and false-positive rate (FPR) is performed. A high positive correlation argues for summarizing the studies with an ROC curve. In the absence of such correlation, a test of homogeneity is applied separately to the estimates of sensitivity (TPR) and specificity (TNR) to evaluate whether differences among studies are due to chance alone. If the estimates are homogeneous, a summary point estimate and confidence intervals (Cls) are calculated. As a final step, subgroup anal yses can be performed to assess alternative explanations of variability in TPR and FPR. Within groups defined by the presence or absence of symptoms of venous thrombosis, a negative correlation between TPR and FPR and homogeneity among studies were found. For symptomatic patients, the summary TPR was 0.97 with a 95% CI of (0.94, 0.99) and the summary TNR was 0.97 (0.95, 0.99). For asymptomatic patients, the summary TPR was 0.66 (0.50, 0.81), and the summary TNR was 0.96 (0.90, 0.99). The difference in TPR between symptomatic and asymptomatic patients was statistically significant. There was no evidence that test referral bias or lack of independent interpretation of test results influenced these findings. It is concluded that this meta-analytic method represents a quantitative ap proach to summarizing the performances of diagnostic tests. It provides criteria for deciding among the approaches of fitting a summary ROC curve, calculating a summary point esti mate, or reporting ranges of TPRs and TNRs. A summary point estimate is introduced for use when TPR and FPR are not positively correlated but index test characteristics are homogeneous among studies. This method also allows examination of alternative expla nations of differences in test performance characteristics such as differences among sub groups of patients or biases in study design. Key words: meta-analysis; technology as sessment; diagnostic test accuracy. (Med Decis Making 1993;13:253-257) |
| Издатель | Sage Publications |
| Название | A Meta-analytic Method for Summarizing Diagnostic Test Performances |
| Тип | Journal Article |
| DOI | 10.1177/0272989X9301300313 |
| Print ISSN | 0272-989X |
| Журнал | Medical Decision Making |
| Том | 13 |
| Первая страница | 253 |
| Последняя страница | 257 |
| Выпуск | 3 |
| Библиографическая ссылка | Sox HCJrBlatt, MA, Higgins MC, Marton KIMedical Decision Making. 1st ed. Boston: Butterworths, 1988. |
| Библиографическая ссылка | Kardaun Jwpf , Kardaun Owjf. Comparative diagnostic performance of three radiological procedures for the detection of lumbar disk herniation. Meth Inform Med. 1990;29:12-22. |
| Библиографическая ссылка | Hurlbut III TA, Littenberg B., The Diagnostic Technology Assessment Consortium. The diagnostic accuracy of rapid dipstick tests to predict urinary tract infection . Am J Clin Pathol. 1991; 96:582-8. |
| Библиографическая ссылка | Tosteson AN, Begg CBA general regression methodology for ROC curve estimation. Med Decis Making.1988;8:204-15. |
| Библиографическая ссылка | Diamond GAA receiver operating characteristic curve that is invariant relative to selection bias. Med Decis Making.1987;4:238-43. |
| Библиографическая ссылка | Conover WJPractical Nonparametric Statistics. New York: John Wiley and Sons, 1971;99-104. |
| Библиографическая ссылка | Snedecor GW, Cochran WGStatistical Methods. 6th ed. Ames, Iowa: Iowa State University Press, 1967:215-9. |
| Библиографическая ссылка | Mehta CR, Patel NRA network algorithm for performing Fisher's exact test in r × c contingency tables. J Am Statist Assoc.1983; 78:427-34. |
| Библиографическая ссылка | SAS Institute Inc., SAS/STAT User's guide, Version 6. Fourth edition, volume 1, Cary, NC: SAS Institute Inc., 1989;865-6. |
| Библиографическая ссылка | Wilks SSMathematical Statistics. New York: John Wiley and Sons, 1962:277-328. |
| Библиографическая ссылка | Raghavendra BN, Horii SC, Hilton S., et al. Deep venous thrombosis : detection by probe compression of veins. J Ultrasound Med.1986;5:89-95. |
| Библиографическая ссылка | Aitken Agf, Godden DJReal-time ultrasound diagnosis of deep vein thrombosis: a comparison with venography. Clin Radiol.1987;38:309-13. |
| Библиографическая ссылка | Lensing Awa , Prandoni P., Brandjes D., et al. Detection of deep vein thrombosis by real-time-b-mode ultrasonography. N Engl J Med. 1989;329:342-5. |
| Библиографическая ссылка | Monreal M., Montserrat E., Salvador R., et al. Real-time ultrasound for diagnosis of symptomatic venous thrombosis and for screening of patients at risk: correlation with ascending conventional venography. Angiology.1989;40:527-33. |
| Библиографическая ссылка | Appleman PT , De Jong TE, Lampmann LE Deep venous thrombosis of the leg: ultrasound findings. Radiology. 1987;163:743-6. |
| Библиографическая ссылка | Borris LC, Christiansen HM, Lassen MR, et al. Comparison of real-time-b-mode ultrasonography and bilateral ascending phlebography for detection of postoperative deep vein thrombosis following elective hip surgery. Thromb Haemostas.1989;61:363-5. |
| Библиографическая ссылка | Froehlich JA , Dorfman GS, Cronan JJ, et al. Compression ultrasonography for the detection of deep venous thrombosis in patients who have a fracture of the hip. J Bone Joint Surg. 1989;71-A:249-56. |
