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Systematic survey of randomized trials evaluating the impact of alternative diagnostic strategies on patient-important outcomes.
- Source :
-
Journal of clinical epidemiology [J Clin Epidemiol] 2017 Apr; Vol. 84, pp. 61-69. Date of Electronic Publication: 2017 Jan 04. - Publication Year :
- 2017
-
Abstract
- Objectives: To provide a perspective on the current practice of randomized clinical trials (RCTs) of diagnostic strategies focusing on patient-important outcomes.<br />Study Design and Setting: We conducted a comprehensive search of MEDLINE and included RCTs published in full-text reports that evaluated alternative diagnostic strategies.<br />Results: Of 56,912 unique citations, we sampled 7,500 and included 103 eligible RCTs, therefore suggesting that MEDLINE includes approximately 781 diagnostic RCTs. The 103 eligible trials reported on: mortality (n = 41; 39.8%); morbidities (n = 63; 61.2%); symptoms/quality of life/functional status (n = 14; 13.6%); and on composite end points (n = 10; 9.7%). Of the studies that reported statistically significant results (n = 12; 11.6%), we judged 7 (58.3%) as at low risk of bias with respect to missing outcome data and 4 (33.3%) as at low risk of bias regarding blinding. Of the 41 RCTs that reported on mortality, only one (2.4%) reported statistically significant results. Of 63 RCTs addressing morbidity outcomes, 11 (17.5%) reported statistically significant results, all of which reported relative effects of greater than 20%.<br />Conclusion: RCTs of diagnostic tests are not uncommon, and sometimes suggest benefits on patient-important outcomes but often suffer from limitations in sample size and conduct.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1878-5921
- Volume :
- 84
- Database :
- MEDLINE
- Journal :
- Journal of clinical epidemiology
- Publication Type :
- Academic Journal
- Accession number :
- 28063913
- Full Text :
- https://doi.org/10.1016/j.jclinepi.2016.12.009