Evidence base of clinical diagnosis - The architecture of diagnostic research
Evidence base of clinical diagnosis - The architecture of diagnostic research
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DOI：
10.1136/bmj.324.7336.539
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发表时间：
2002-03-02
影响因子：
--
通讯作者：
Haynes, RB
中科院分区：
文献类型：
--
作者：
Sackett, DL;Haynes, RB
在临床医学和科学方法之间的接口上已经花费了相当大的努力，以实现诊断测试的最大有效性和有用性。本文侧重于诊断研究中出现的特定类型的问题以及用于回答这些问题的研究架构(将这些临床问题转换为适当的研究设计)。作为一个例子，我们将以血浆B型利钠肽(BNP)浓度在诊断左心功能不全中的价值评估为例。与其他形式的临床研究一样，有几种不同的方法来研究体征或实验室测试的潜在或实际诊断价值，每种方法都适用于一种问题，而不适用于其他问题。在推定的诊断试验和目标疾病(例如，BNP浓度和左心功能不全)之间可能存在的关系的问题中，有四个问题最相关。
Considerable effort has been expended at the interface between clinical medicine and scientific methods to achieve the maximum validity and usefulness of diagnostic tests. This article focuses on the specific kinds of questions that arise in diagnostic research and the study architectures (the conversions of these clinical questions into appropriate research designs) used to answer them. As an example we shall take shall take assessment of the value of the plasma concentration of B-type natriuretic peptide (BNP) in the diagnosis of left ventricular dysfunction. 1 Randomised controlled trials are dealt with elsewhere.As in other forms of clinical research, there are several different ways studying the potential or real diagnostic value of a physical sign or laboratory test, and each is appropriate to one kind of question and inappropriate for others. Among the possible questions about the relation between a putative diagnostic test and a target disorder (for example, the concentration of BNP and left ventricular dysfunction), four are most relevant.