Open AccessAssessing Diagnostic Tests: How to Correct for the Combined Effects of Interpretation and Reference Standard
Author(s) -
Ahmet Omurtag,
André A. Fenton
Publication year - 2012
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0052221
Subject(s) - sensitivity (control systems) , reliability (semiconductor) , diagnostic accuracy , gold standard (test) , reference values , standard deviation , computer science , interpreter , diagnostic test , statistics , standard error , calibration , interpretation (philosophy) , medical physics , medicine , mathematics , radiology , pediatrics , physics , power (physics) , quantum mechanics , electronic engineering , engineering , programming language
We describe a general solution to the problem of determining diagnostic accuracy without the use of a perfect reference standard and in the presence of interpreter variability. The accuracy of a diagnostic test is typically determined by comparing its outcomes with those of an established reference standard. But the accuracy of the standard itself and those of the interpreters strongly influence such assessments. We use our solution to examine the effects of the properties of the standard, the reliability of the interpreters, and the prevalence of abnormality on the measured sensitivity and specificity. Our results provide a method of systematically adjusting the measured sensitivity and specificity in order to estimate their true values. The results are validated by simulations and their detailed application to specific cases are described.
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