Scales Charles D, Dahm Philipp, Sultan Shahnaz, Campbell-Scherer Denise, Devereaux P J
Division of Urology, Department of Surgery, Duke University, Durham, North Carolina, USA.
J Urol. 2008 Aug;180(2):469-76. doi: 10.1016/j.juro.2008.04.026. Epub 2008 Jun 11.
Urologists frequently confront diagnostic dilemmas, prompting them to select, perform and interpret additional diagnostic tests. Before applying a given diagnostic test the user should ascertain that the chosen test would indeed help decide whether the patient has a particular target condition. In this article in the Users' Guide to the Urological Literature series we illustrate the guiding principles of how to critically appraise a diagnostic test, interpret its results and apply its findings to the care of an individual patient.
The guiding principles of how to evaluate a diagnostic test are introduced in the setting of a clinical scenario. We propose a stepwise approach that addresses the question of whether the study results are likely to be valid, what the results are and whether these results would help urologists with the treatment of their individual patients.
Some of the issues urologists should consider when assessing the validity of a diagnostic test study are how the authors assembled the study population, whether they used blinding to minimize bias and whether they used an appropriate reference standard in all patients to determine the presence or absence of the target disorder. Urologists should next evaluate the properties of the diagnostic test that indicate the direction and magnitude of change in the probability of disease for a particular test result. Finally, urologists should ask a series of questions to understand how the diagnostic test may impact the care of their patients.
Application of the guides presented in this article will allow urologists to critically appraise studies of diagnostic tests. Determining the study validity, understanding the study results and assessing the applicability to patient care are 3 fundamental steps toward an evidence-based approach to choosing and interpreting diagnostic tests.
泌尿外科医生经常面临诊断难题，这促使他们选择、进行并解读额外的诊断测试。在应用某一特定诊断测试之前，使用者应确定所选测试确实有助于判定患者是否患有特定目标疾病。在本《泌尿外科文献用户指南》系列文章中，我们阐述了如何严格评估诊断测试、解读其结果并将其发现应用于个体患者护理的指导原则。
在临床情景中介绍评估诊断测试的指导原则。我们提出一种逐步的方法，该方法涉及研究结果是否可能有效、结果是什么以及这些结果是否有助于泌尿外科医生治疗其个体患者的问题。
泌尿外科医生在评估诊断测试研究的有效性时应考虑的一些问题包括作者如何组建研究人群、他们是否采用盲法以尽量减少偏倚以及他们是否在所有患者中使用适当的参考标准来确定目标疾病的存在与否。泌尿外科医生接下来应评估诊断测试的特性，这些特性表明特定测试结果下疾病概率变化的方向和幅度。最后，泌尿外科医生应提出一系列问题，以了解诊断测试可能如何影响其患者的护理。
应用本文中提出的指南将使泌尿外科医生能够严格评估诊断测试的研究。确定研究的有效性、理解研究结果以及评估对患者护理的适用性是采用循证方法选择和解读诊断测试的三个基本步骤。
