A comparison of criterion standard methods to diagnose acute heart failure
Congestive Heart Failure, 05/03/2012
Collins SP et al. – 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.
- 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.