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诊断性临床研究报告规范-——STARD规范解读

2014-08-13 MedSci MedSci原创

诊断措施千变万化, 新检查方法不断涌现, 已有检查技术日趋完善。设计和报告质量不佳的诊断研究所得出的夸大或偏倚结果会导致某些技术的过早推广, 使临床医生作出错误的治疗决策。在某项诊断措施用于临床前进行严格评估, 不仅能减少因错误估计其准确性而导致意外临床结果发生外, 还能避免不必要的检查, 降低医疗费用。因此, 确定某项诊断措施诊断准确性的研究在这一评估程序中至关重要。 在诊断准确性研究中,


下面是2003版STARD规范:

诊断措施千变万化, 新检查方法不断涌现, 已有检查技术日趋完善。设计和报告质量不佳的诊断研究所得出的夸大或偏倚结果会导致某些技术的过早推广, 使临床医生作出错误的治疗决策。在某项诊断措施用于临床前进行严格评估, 不仅能减少因错误估计其准确性而导致意外临床结果发生外, 还能避免不必要的检查, 降低医疗费用。因此, 确定某项诊断措施诊断准确性的研究在这一评估程序中至关重要。

在诊断准确性研究中, 将一个或多个待评估诊断措施所得结果与金标准诊断措施所得结果相比较, 两组均在可能有目标病情的受试者中进行。在这里, “ 检查” 一词是指任何用于进一步获取病人健康状况的方法, 包括从病史和查体、实验室检查、影像学检查、功能检查和组织病理学检查中所获的信息。“ 目标病情” 是指某种具体疾病或其它任何可能需进行临床干预如尝试进一步诊断措施, 或开始、调整或终止某项治疗的显在病态表现。在该体系中, “ 金标准” 被认为是当前已有的确定目标病情存在与否的最佳方法。金标准可以是单一方法, 也可以是几种方法的组合。它不仅包括实验室检查、影像学检查、病理学检查, 还包括对受试者专门的临床随访。“ 准确性” 是指试验诊断措施待测指标, 与金标准所得结果之间的吻合程度。诊断准确性可以用多种方式来表示, 包括灵敏度和特异度、似然比、诊断优势比及受试者工作特征曲线下面积。

诊断准确性研究的内在和外在真实性存在着多种潜在威胁。一篇分析了至年间发表于四种主要医学期刊的诊断准确性研究的调查报告提示, 这些研究的方法学质量充其量也就处于中等水平。但由于许多报告均缺少有关诊断研究的设计、实施、分析等关键要素的信息, 该评价也因此受到了局限。一些分析的作者也证实了诊断研究的设计、实施等关键信息缺失的事实。同其它任何类型的研究一样, 研究设计的缺陷可导致结果出现偏倚。有报告称, 带有特定设计特征的诊断研究, 与没有这类缺陷的研究相比, 可能作出偏倚的、乐观的诊断准确性评估。

制定诊断准确性报告标准旨在提高诊断准确性研究报告的质量。完整、准确的报告便于读者发现研究中可能存在的偏倚内在真实性, 评价研究结果的普适性和推广性外部效度。

诊断性研究STARD报告规范checklist

章节与主题

项目

 解释

On page

TITLE/ABSTRACT/
KEYWORDS
题目摘要关键词

1

Identify the article as a study of diagnostic accuracy (recommend MeSH heading 'sensitivity and specificity').
确定文章为诊断性研究,推荐用MESH主题词作为关键词

 

INTRODUCTION
前言

2

State the research questions or study aims, such as estimating diagnostic accuracy or comparing accuracy between tests or across participant groups.
描述研究目的或问题,如评估诊断准确性或比较不同诊断方法之间的差异,或比较不同人群间差异

 

METHODS

 

 

 

Participants
受试者

3

The study population: The inclusion and exclusion criteria, setting and locations where data were collected.
研究人群:纳入与排除标准,数据收集的背景和地点

 

 

4

Participant recruitment: Was recruitment based on presenting symptoms, results from previous tests, or the fact that the participants had received the index tests or the reference standard?
受试者招募:基于症状表现,既往检查结果或是受试已接受过待测检测,或初步检测,或金标准检测的结果。

 

 

5

Participant sampling: Was the study population a consecutive series of participants defined by the selection criteria in item 3 and 4? If not, specify how participants were further selected.
抽样:研究人群是否根据条目3,4中的选择标准确定序列?如果否,请描述如何确定样本?

 

 

6

Data collection: Was data collection planned before the index test and reference standard were performed (prospective study) or after (retrospective study)?
数据收集:在指标检查和参考标准检查之前(前瞻性)还是之后(回顾性)

 

Test methods
检查方法

7

The reference standard and its rationale.
参考标准及其原理

 

 

8

Technical specifications of material and methods involved including how and when measurements were taken, and/or cite references for index tests and reference standard.
相关资料与方法的技术说明,包括何时和怎样进行测量的,和/或引用参考文献说明指标检查和参考标准检查

 

 

9

Definition of and rationale for the units, cut-offs and/or categories of the results of the index tests and the reference standard.
指标检查和参考标准检查的结果(单位),临床界和/或分类的标准

 

 

10

The number, training and expertise of the persons executing and reading the index tests and the reference standard.
执行和读取指标检查和参考检查的人员的数量,培训及其专业技能

 

 

11

Whether or not the readers of the index tests and reference standard were blind (masked) to the results of the other test and describe any other clinical information available to the readers.
执行和读取指标检查和参考标准检查的人员是否采用盲法?描述其它可获取的临床资料

 

Statistical methods
统计

12

Methods for calculating or comparing measures of diagnostic accuracy, and the statistical methods used to quantify uncertainty (e.g. 95% confidence intervals).
计算和比较诊断性的方法,以及不确定性的定量统计方法,如95%CI

 

 

13

Methods for calculating test reproducibility, if done.
如果已做,计算检查可重复性的方法。

 

RESULTS

 

 

 

Participants
受试者

14

When study was performed, including beginning and end dates of recruitment.
研究何时完成,包括受试者招募的起止时间

 

 

15

Clinical and demographic characteristics of the study population (at least information on age, gender, spectrum of presenting symptoms).
研究人群的临床特征和人口学特征(如年龄,性别,疾病谱等)

 

 

16

The number of participants satisfying the criteria for inclusion who did or did not undergo the index tests and/or the reference standard; describe why participants failed to undergo either test (a flow diagram is strongly recommended).
符合纳入标准,参与了或未参与指标检查和/或参考检查的人数,说明为什么这些患者没有参与任一检查(推荐画出流程图)

 

Test results
检查结果

17

Time-interval between the index tests and the reference standard, and any treatment administered in between.
从指标检查到参考标准检查间的时间间隔,及在此期间是否给予任何治疗

 

 

18

Distribution of severity of disease (define criteria) in those with the target condition; other diagnoses in participants without the target condition.
在出现了目标情况的受试者中描述疾病的严重程度分布状况,以及未出现目标情况的受试者中说明其它诊断

 

 

19

A cross tabulation of the results of the index tests (including indeterminate and missing results) by the results of the reference standard; for continuous results, the distribution of the test results by the results of the reference standard.
指标检查结果(包括不确定和丢失的结果)和参考标准检查结果的四格表。以及为了进一步检查而获得的检查结果分布和参考标准检查结果的四格表

 

 

20

Any adverse events from performing the index tests or the reference standard.
在进行指标检查和参考标准检查过程中,是否出现不良事件

 

Estimates
评估

21

Estimates of diagnostic accuracy and measures of statistical uncertainty (e.g. 95% confidence intervals).
诊断准确性的评估及统计学不确定性的衡量

 

 

22

How indeterminate results, missing data and outliers of the index tests were handled.
指标检查的不确定性结果,丢失结果(失访结果),以及异常值的处理情况

 

 

23

Estimates of variability of diagnostic accuracy between subgroups of participants, readers or centers, if done.
如果已做,评估诊断准确性在受试者的不同亚组间,不同结果判读者间,以及不同中心间的变异情况。

 

 

24

Estimates of test reproducibility, if done.    
如果已做,评估检查的可重复性。

 

DISCUSSION
讨论

25

Discuss the clinical applicability of the study findings.
讨论研究结果的临床适用性

 

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    2015-04-27 swallow
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    2014-08-16 wp4575

    东西还是不错的

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2026254, encodeId=bec52026254dc, content=<a href='/topic/show?id=6cbc915966c' target=_blank style='color:#2F92EE;'>#诊断性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91596, encryptionId=6cbc915966c, topicName=诊断性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=83a4244, createdName=swallow, createdTime=Mon Apr 27 15:20:00 CST 2015, time=2015-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1981044, encodeId=356d19810446a, content=<a href='/topic/show?id=10f3e33982f' target=_blank style='color:#2F92EE;'>#研究报告#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73398, encryptionId=10f3e33982f, topicName=研究报告)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Sat Jun 06 01:20:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=11138, encodeId=4ec01113833, content=东西还是不错的, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=06d5107248, createdName=wp4575, createdTime=Sat Aug 16 07:09:00 CST 2014, time=2014-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1295653, encodeId=dc65129565375, content=<a href='/topic/show?id=b69d5605275' target=_blank style='color:#2F92EE;'>#报告规范#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56052, encryptionId=b69d5605275, topicName=报告规范)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=af60254, createdName=mhm289, createdTime=Fri Aug 15 02:20:00 CST 2014, time=2014-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=11116, encodeId=7e4511116a8, content=新版的都出来还在说旧的, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=49.118.96.229, createdTime=Wed Aug 13 18:35:00 CST 2014, time=2014-08-13, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2026254, encodeId=bec52026254dc, content=<a href='/topic/show?id=6cbc915966c' target=_blank style='color:#2F92EE;'>#诊断性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91596, encryptionId=6cbc915966c, topicName=诊断性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=83a4244, createdName=swallow, createdTime=Mon Apr 27 15:20:00 CST 2015, time=2015-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1981044, encodeId=356d19810446a, content=<a href='/topic/show?id=10f3e33982f' target=_blank style='color:#2F92EE;'>#研究报告#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73398, encryptionId=10f3e33982f, topicName=研究报告)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Sat Jun 06 01:20:00 CST 2015, time=2015-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=11138, encodeId=4ec01113833, content=东西还是不错的, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=06d5107248, createdName=wp4575, createdTime=Sat Aug 16 07:09:00 CST 2014, time=2014-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1295653, encodeId=dc65129565375, content=<a href='/topic/show?id=b69d5605275' target=_blank style='color:#2F92EE;'>#报告规范#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56052, encryptionId=b69d5605275, topicName=报告规范)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=af60254, createdName=mhm289, createdTime=Fri Aug 15 02:20:00 CST 2014, time=2014-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=11116, encodeId=7e4511116a8, content=新版的都出来还在说旧的, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=49.118.96.229, createdTime=Wed Aug 13 18:35:00 CST 2014, time=2014-08-13, status=1, ipAttribution=)]
    2014-08-13 49.118.96.229

    新版的都出来还在说旧的

    0

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