Cook D J, Brun-Buisson C, Guyatt G H, Sibbald W J
Department of Medicine, Victoria Hospital, London, ON, Canada.
Crit Care Med. 1994 Aug;22(8):1314-22.
To present criteria to aid intensive care workers in the assessment of diagnostic technologies, using the example of bronchoalveolar lavage for the evaluation of ventilator-associated pneumonia.
MEDLINE was used to search for articles published from 1969 to the present that concerned diagnostic tests, diagnostic technology, pneumonia, and critically ill patients.
Clinical investigations, case control studies, case series, and experimental data on the use of bronchoalveolar lavage. Studies of diagnostic technology were also included.
We extracted relevant data in duplicate, independently.
Diagnostic technology assessment should begin by establishing the capability of the technology under ideal or laboratory conditions, followed by an exploration of the range of possible uses as well as the accuracy of the test. Bronchoalveolar lavage is a well-established technology for the diagnosis of pneumonia in immunocompromised patients. Studies of the accuracy of bronchoalveolar lavage in ventilator-dependent but nonimmunocompromised patients have shown promising diagnostic accuracy. Accuracy, however, is insufficient for dissemination of a test; an evaluation of the impact of a test on management decisions and, most importantly, on patient outcome, is required. Investigators have not addressed the full impact of bronchoalveolar lavage, and, even if the test is accurate, there are reasons to doubt whether patients will be better off if the test becomes part of routine clinical practice.
We present guidelines for the assessment of diagnostic technology, and apply them to bronchoalveolar lavage for the evaluation of ventilator-associated pneumonia. Bronchoalveolar lavage has been studied in both the laboratory and clinical setting, and the diagnostic sensitivity and specificity of this technique are high. Further randomized trials evaluating management decisions and patient benefit would facilitate decisions regarding the appropriate dissemination of bronchoalveolar lavage.
以支气管肺泡灌洗术评估呼吸机相关性肺炎为例，提出有助于重症监护人员评估诊断技术的标准。
使用MEDLINE检索1969年至今发表的有关诊断试验、诊断技术、肺炎及重症患者的文章。
关于支气管肺泡灌洗术应用的临床研究、病例对照研究、病例系列研究及实验数据。也纳入诊断技术研究。
我们独立地重复提取相关数据。
诊断技术评估应首先在理想或实验室条件下确定该技术的能力，随后探究其可能的应用范围以及检测的准确性。支气管肺泡灌洗术是诊断免疫功能低下患者肺炎的成熟技术。对依赖呼吸机但免疫功能正常患者支气管肺泡灌洗术准确性的研究显示出有前景的诊断准确性。然而，准确性不足以推广一项检测；还需要评估一项检测对管理决策，以及最重要的对患者结局的影响。研究者尚未探讨支气管肺泡灌洗术的全面影响，而且即使该检测准确，也有理由怀疑如果该检测成为常规临床实践的一部分患者是否会受益更多。
我们提出诊断技术评估指南，并将其应用于支气管肺泡灌洗术以评估呼吸机相关性肺炎。支气管肺泡灌洗术已在实验室和临床环境中进行研究，该技术的诊断敏感性和特异性都很高。进一步评估管理决策和患者获益的随机试验将有助于就支气管肺泡灌洗术的适当推广做出决策。
