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Editorials |

Diagnostic Test Accuracy and Clinical Decision Making

John Cornell, PhD, Associate Editor; Cynthia D. Mulrow, MD, MSc, Deputy Editor; and A. Russell Localio, PhD, Associate Editor
[+] Article, Author, and Disclosure Information

Potential Financial Conflicts of Interest: None disclosed.

Corresponding Author: John E. Cornell, PhD, Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900.

Ann Intern Med. 2008;149(12):904-906. doi:10.7326/0003-4819-149-12-200812160-00011
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Selecting a diagnostic test is a complex and sometimes bewildering task. Systematic reviews of diagnostic test accuracy provide only some of the essential information that physicians need. Choice of a diagnostic test is embedded within a dynamic multistage screening and decision-making context in which past clinical assessments and review of personal and family medical history determine the need for testing. For diagnostic tests, it is important to understand not only the test characteristics, such as sensitivity and specificity, but also the relative benefits and harms from actions in response to test results for subgroups of patients and the individual patient. Authors of systematic reviews of diagnostic test accuracy need to see beyond reporting the summary receiver-operating characteristic (ROC) curves and summary measures of diagnostic accuracy. By examining the expected downstream harms and benefits of positive and negative test results, authors can link diagnostic accuracy to clinical decision making.

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