MethodsforEvaluatingthePerformanceofDiagnosticTes：用于诊断测试的性能评价方法.pptVIP

Methods for Evaluating the Performance of Diagnostic Tests in the Absence of a “Gold Standard:”  A Latent Class Model Approach Elizabeth S. Garrett Division of Biostatistics Johns Hopkins University December 9, 2002 Evaluating Diagnostic Criteria Relatively few areas of medicine have true “gold standard” tests, where test is perfectly accurate. “Pathognomic indicators” When indicator is present, disease is present When indicator is absent, disease is absent Other situations: Combination of signs and symptoms provide very accurate diagnosis. Disease process is not well understood: controversy exists about how to define diagnosis. Disease process is well understood but measuring disease via signs and symptoms is difficult. Diagnostic Criteria in Psychiatry Currently, the DSM (Diagnostic and Statistical Manual of Mental Disorders) is the standard for defining mental disorders. Diagnostic algorithms are provided with which a determination of disorder absence or presence can be made Examples: major depression, schizophrenia, autism, alcoholism, generalized anxiety disorder. How do we validate the DSM criteria? How can we be sure that these definitions are valid measures? How can we determine the sensitivity and specificity of these measures? Is there a gold standard? Is psychiatrist’s diagnosis a gold standard? What types of individuals are the diagnostic criteria diagnosing as depressed? How often are individuals misdiagnosed? What are the implications of a positive or negative diagnosis? Example: Major Depression Epidemiologic Catchment Area Study (ECA): Collected mental health data on individuals in 5 cities, beginning in 1981. Our sample: epidemiologic sample of 1322 individuals in the East Baltimore area collected in 1993 (wave 3). Depression questions are from Diagnostic Interview Schedule, which has been shown to be valid and reliable (Robins et al., 1981) Questions about symptom presence were asked for the DSM major depression symptoms and coded as “pres