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,
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/ |
1 |
Identify the article as a study of diagnostic accuracy (recommend MeSH heading 'sensitivity and specificity'). |
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INTRODUCTION |
2 |
State the research questions or study aims, such as estimating diagnostic accuracy or comparing accuracy between tests or across participant groups. |
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METHODS |
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Participants |
3 |
The study population: The inclusion and exclusion criteria, setting and locations where data were collected. |
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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? |
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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. |
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6 |
Data collection: Was data collection planned before the index test and reference standard were performed (prospective study) or after (retrospective study)? |
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Test methods |
7 |
The reference standard and its rationale. |
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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. |
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9 |
Definition of and rationale for the units, cut-offs and/or categories of the results of the index tests and the reference standard. |
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10 |
The number, training and expertise of the persons executing and reading the index tests and the reference standard. |
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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. |
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Statistical methods |
12 |
Methods for calculating or comparing measures of diagnostic accuracy, and the statistical methods used to quantify uncertainty (e.g. 95% confidence intervals). |
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13 |
Methods for calculating test reproducibility, if done. |
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RESULTS |
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Participants |
14 |
When study was performed, including beginning and end dates of recruitment. |
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15 |
Clinical and demographic characteristics of the study population (at least information on age, gender, spectrum of presenting symptoms). |
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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). |
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Test results |
17 |
Time-interval between the index tests and the reference standard, and any treatment administered in between. |
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18 |
Distribution of severity of disease (define criteria) in those with the target condition; other diagnoses in participants without the target condition. |
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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. |
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20 |
Any adverse events from performing the index tests or the reference standard. |
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Estimates |
21 |
Estimates of diagnostic accuracy and measures of statistical uncertainty (e.g. 95% confidence intervals). |
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22 |
How indeterminate results, missing data and outliers of the index tests were handled. |
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23 |
Estimates of variability of diagnostic accuracy between subgroups of participants, readers or centers, if done. |
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24 |
Estimates of test reproducibility, if done. |
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DISCUSSION |
25 |
Discuss the clinical applicability of the study findings. |
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在此留言
#诊断性#
52
#研究报告#
36
东西还是不错的
112
#报告规范#
47
新版的都出来还在说旧的
140