Utility of Composite Reference Standards and Latent Class Analysis in Evaluating the Clinical Accuracy of Diagnostic Tests for Pertussis
Autor: | Andrew L. Baughman, William W. Thompson, Gary N. Sanden, Peter M. Strebel, Kristine M. Bisgard, Margaret M. Cortese |
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Rok vydání: | 2008 |
Předmět: |
Adult
Microbiology (medical) Disease status Bordetella pertussis Pathology medicine.medical_specialty Adolescent Whooping Cough Clinical Biochemistry Immunology Polymerase Chain Reaction Sensitivity and Specificity Predictive Value of Tests Statistics otorhinolaryngologic diseases medicine Humans Immunology and Allergy Serologic Tests Child Reference standards Whooping cough Bacteriological Techniques Models Statistical biology business.industry Clinical and Diagnostic Laboratory Immunology Diagnostic test Diagnostic marker Middle Aged Reference Standards medicine.disease biology.organism_classification Latent class model Predictive value of tests business |
Zdroj: | Clinical and Vaccine Immunology. 15:106-114 |
ISSN: | 1556-679X 1556-6811 |
Popis: | Numerous evaluations of the clinical sensitivity and specificity of PCR and serologic assays for Bordetella pertussis have been hampered by the low sensitivity of culture, the gold standard test, which leads to biased accuracy estimates. The bias can be reduced by using statistical approaches such as the composite reference standard (CRS) (e.g., positive if culture or serology positive; negative otherwise) or latent class analysis (LCA), an internal reference standard based on a statistical model. We illustrated the benefits of the CRS and LCA approaches by reanalyzing data from a 1995 to 1996 study of cough illness among 212 patients. The accuracy of PCR in this study was evaluated using three reference standards: culture, CRS, and LCA. Using specimens obtained 0 to 34 days after cough onset, estimates of the sensitivity of PCR obtained using CRS (47%) and LCA (34%) were lower than the culture-based estimate (62%). The CRS and LCA approaches, which utilized more than one diagnostic marker of pertussis, likely produced more accurate reference standards than culture alone. In general, the CRS approach is simple, with a well-defined disease status. LCA requires statistical modeling but incorporates more indicators of disease than CRS. When three or more indicators of pertussis are available, these approaches should be used in evaluations of pertussis diagnostic tests. |
Databáze: | OpenAIRE |
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