Guidelines for Diagnostic Tests and Diagnostic Accuracy in Surgical Research

OBJECTIVE: This is a guideline review of the application of diagnostic tests and diagnostic accuracy in surgical research. SUMMARY BACKGROUND DATA: There is an increasing use of diagnostic tests in surgery, and an understanding of the accuracy for each test is important for surgeons. METHODS: This methodological review outlines the basic concepts of diagnostic test accuracy, including sensitivity, specificity, diagnostic odds ratio, likelihood ratios, and predictive values. Sources of bias in diagnostic accuracy studies are explained in simplified terms. The graphical methods used to present diagnostic accuracy are demonstrated. Study quality issues are outlined using published guidelines. Finally, the principles of diagnostic meta-analysis, including more advanced approaches such as bivariate and hierarchical summary receiver operating characteristic methods are explained. CONCLUSION: In the era of evidence-based surgery, the ability to understand and interpret the fundamental principles of diagnostic accuracy literature is vital to improve patient care and reduce the confusion in clinical practice over the most appropriate diagnostic test.