APPRAISAL TIPS FOR AN ARTICLE ON DIAGNOSIS

I. EVALUATING Why is it Important What to Look For

DIRECTNESS
1. Does the study provide a Many times, the patient you Seek the opinion of an
direct enough answer to are managing, the treatment expert (this might be
your clinical question in you are about to use, or the you), or your colleagues.
terms of patients (P), outcome you are trying to
examination (E) used and prevent - are not exactly the
disease or outcome (O) same as those studied by the
being diagnosed? authors of a paper. In this
situation, you need to decide if
you can use the study results
at all. The decision requires
some expertise on the disease
under question.

II. APPRASING VALIDITY Why is it Important What to Look For

1. Was the reference A reference standard that is Look for standard

standard an acceptable accepted by the scientific
one? community as the definition of
disease is the yardstick with
which the performance of the
test is measured
diagnostic test(s) used to
ascertain presence of
disease in the study
population.

2. Was the reference Interpretation of the test and Look for terms such as
standard interpreted the gold standard should be “independent” or “blind” to
independently from the done independently to describe how evaluations
test in question? minimize bias. were made.

appraisal tip_dx_2006 1
 III. INTERPRETING Why is it Important What to Look For
RESULTS
1. What likelihood ratios Likelihood ratios allow us to If LR’s are not reported,
were associated with the convert pre-test to post-test 2xn tables need to be
range of possible test probability, even if tests have reconstructed, and
results? more than just 2 results calculations need to be
(positive or negative). made.

IV. ASSESING Why is it Important What to Look For

APPLICABILITY
1. Are there biologic issues There should be adequate Look for characteristics of
that may affect accuracy consideration of variables that the study population and
of the test? (Consider the may affect test performance assess if the authors
influence of sex, co- and utilization in our population attempted to isolate
morbidity, race, age and of interest. variables or made
pathology) statistical adjustments.

2. Are there socio-economic Social, cultural and economic
issues that may affect contexts that may potentially
accuracy of the test? affect diagnostic test
performance have to be taken
into account particularly for
interventions that require
socio-cultural sensitivity (e.g.
questionnaires) and/or
provider compliance.
Check if the tests done
were locally validated,
you may need to do
validation studies in your
locale. Look for attempts
to compute costs.

V. INDIVIDUALIZING THE Why is it Important What to Look For

RESULTS
1. Will the test result allow There must be a local Look at P, E, and O in the
you to commit to or reject laboratory that can do the test study. Check if the test is
a differential diagnosis? accurately and the result available locally. Check if
should help you in patient LRs will help you rule in
management. or rule out a differential
diagnosis.

2. Will the patient be better It is important that we are able
off with the result of the to offer some interventions
test? after the results come in. This
can be in the form of
counseling and/or treatment or
further tests. Are these
available and affordable?
Look at the options for
further work up or
treatment of the disease
you are interested in.
Know the resources
available to your patient.

appraisal tip_dx_2006 2