A comparison of criterion standard methods to diagnose acute heart failure

Congestive Heart Failure, 05/03/2012

Researchers should consider this when choosing between the various criterion standard approaches when evaluating new index tests.

Methods

  • In a prospective observational study of patients with signs and symptoms of AHFS, 3 criterion standards were examined:
    • The treating ED physician’s diagnosis;
    • The hospital discharge diagnosis;
    • And a diagnosis based on medical record review by a panel of cardiologists.
  • Using Cohen’s kappa (κ) coefficient, the authors assessed agreement and then compared the different standards by repeatedly setting one as the criterion standard and the other two as index tests.
  • A total of 483 patients were enrolled.
  • Across all criterion standards, patients with AHFS were more likely to have a history of AHFS, congestion on physical examination and chest radiography, and elevated natriuretic peptide levels than those without AHFS.

Results

  • The standards agreed well (cardiology review vs hospital discharge diagnosis, κ=0.74; cardiology review vs ED diagnosis, κ=0.66; ED diagnosis vs hospital discharge diagnosis κ=0.59).
  • Each method had similar sensitivity but differing specificities.
  • Different criterion standards identify different patients from among those being evaluated for AHFS.

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