Weighted 2 x 2 kappa coefficients: recommended indices of diagnostic accuracy for evidence-based practice
Weighted 2 x 2 kappa coefficients: recommended indices of diagnostic accuracy for evidence-based practice
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DOI：
10.1016/j.jclinepi.2008.11.012
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发表时间：
2009-10-01
影响因子：
7.2
通讯作者：
Gilchrist, James M.
中科院分区：
文献类型：
--
作者：
Gilchrist, James M.
目的：临床试验的诊断准确性通常是通过比较试验对个体的分类与某些诊断金标准的分类来评估的。诊断准确性最常用的指标是敏感性、特异性、阳性预测值和阴性预测值。然而，这些措施受到一些诊断决策偶然正确的事实的影响，导致指数之间的值差异很大，临床医生可能会对结果是否表明测试是好还是差感到困惑。根据循证实践的原则，决策应该基于证据而不是猜测，我们可以预期，诊断准确性的度量因此应该是偶然修正的。本文的目的是提倡这一点，并提请注意达到这一要求的指数。研究设计和设置：诊断准确性计算的基本原则作为理解问题及其解决方案的框架提出。结果：不同诊断准确度指标之间的差异可以通过调整来纠正偶然性效应来解决。这产生了一对加权的2 × 2“诊断”卡帕系数，提供了许多理论和实践的优势。结论：推荐常规使用加权2 × 2 kappa系数作为诊断准确性指标。(C) 2009爱思唯尔公司版权所有。
Objectives: The diagnostic accuracy of a clinical test is typically evaluated by comparing the classification of individuals by the test with their classification by some diagnostic gold standard. The most popular indices of diagnostic accuracy are sensitivity, specificity, and positive and negative predictive values. However, these measures are affected by the fact that some diagnostic decisions will be correct by chance, resulting in values that differ widely between indices, and clinicians may be confused as to whether results indicate that a test is good or poor. In keeping with the principle in evidence-based practice that decisions should be based on evidence not guesswork, we might expect that measures of diagnostic accuracy should therefore be chance corrected. The objective of this article was to advocate this and draw attention to indices that achieve this requirement.Study Design and Setting: The principles underlying calculations of diagnostic accuracy are presented as a framework for understanding the problem and its solution.Results: Disparities between different indices of diagnostic accuracy may be resolved by adjusting them to correct for chance effects. This produces a pair of weighted 2 x 2 "diagnostic" kappa coefficients offering a number of theoretical and practical advantages.Conclusion: Routine use of weighted 2 x 2 kappa coefficients as indices of diagnostic accuracy is recommended. (C) 2009 Elsevier Inc. All rights reserved.