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Please, subscribe or login to access full text content. To troubleshoot, please check our FAQs , and if you can't find the answer there, please contact us. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a monograph in OSO for personal use for details see www. OSO version 0. Conflicts of interest: None of the authors has any affiliations or involvement that conflict with the information in this chapter. Samson D, Schoelles KM. Developing the topic and structuring systematic reviews of medical tests: utility of PICOTS, analytic frameworks, decision trees, and other frameworks.
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Search term. Corresponding author: David Samson, M. Telephone voice ; Fax ; email moc. Sanford Sandy Schwartz, Institute of Medicine, 1 Developing the topic creates the foundation and structure of an effective systematic review. Common Challenges The ultimate goal of a medical test review is to identify and synthesize evidence that will help evaluate the impacts on health outcomes of alternative testing strategies. Principles for Addressing the Challenges Principle 1.
Principle 2. Principle 3.
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Consider using decision trees An analytic framework is helpful when direct evidence is lacking, showing relevant key questions along indirect pathways between the test and important clinical outcomes. Principle 4. Sometimes it is sufficient to focus exclusively on accuracy studies Once reviewers have diagrammed the decision tree whereby diagnostic accuracy may affect intermediate and clinical outcomes, it is possible to determine whether it is necessary to include key questions regarding outcomes beyond diagnostic accuracy.
If available trials selected only patients assessed with the old test, do extra cases identified with the new test represent the same spectrum or disease subtypes as trial participants? Does the new test change the definition or spectrum of disease e. Is there heterogeneity of test accuracy and treatment effect i. Principle 5. Illustrations To illustrate the principles above, we describe three examples. Table Examples of initially ambiguous claims that were clarified through the process of topic development.
Summary The immediate goal of a systematic review of a medical test is to determine the health impacts of use of the test in a particular context or set of contexts relative to one or more alternative strategies. Key points are: Reaching the above-stated goals requires an interactive and iterative process of topic development and refinement aimed at understanding and clarifying the claim for a test. This work should be done in conjunction with the principal users of the review, experts, and other stakeholders. The PICOTS typology, analytic framework, simple decision trees, and other organizing frameworks are all tools that can minimize ambiguity, help identify where review resources should be focused, and guide the presentation of results.
Sometimes it is sufficient to focus only on accuracy studies. For example, diagnostic accuracy may be sufficient when the new test is as sensitive and specific as the old test and the new test has advantages over the old test such as having fewer adverse effects, being less invasive, being easier to use, providing results more quickly or costing less. References 1. Chapter 3: Methods of technology assessment.
Assessing medical technologies; pp. Helfand M, Balshem H. J Clin Epidemiol. Technical Review Evidence-based practice center network and health technology assessment in the United States: bridging the cultural gap. Improving the process of developing technical reports for health care decision makers: using the theory of constraints in the evidence-based practice centers.
Woolf SH. An organized analytic framework for practice guideline development: using the analytic logic as a guide for reviewing evidence, developing recommendations, and explaining the rationale. Methodology perspectives: clinical practice guideline development. Rockville, MD: U. Am J Prev Med. Using the principles of randomized controlled trial design to guide test evaluation. Med Decis Making. Epub Sep When and how to study the carotid arteries.
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A meta-analytic review. When is measuring sensitivity and specificity sufficient to evaluate a diagnostic test, and when do we need a randomized trial? Proposals for a phased evaluation of medical tests. The evaluation of diagnostic tests: evidence on technical and diagnostic accuracy, impact on patient outcome and cost-effectiveness is needed. Blue Cross and Blue Shield Association. Full-field digital mammography.
Should FDG PET be used to decide whether a patient with an abnormal mammogram or breast finding at physical examination should undergo biopsy? Acad Radiol. Copyright Notice. Chapter 2. In this Page. Clinical Sports Medicine Collection. Davis AT Collection. Davis PT Collection.
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