Systematic survey of randomized trials evaluating the impact of alternative diagnostic strategies on patient-important outcomes

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El Dib , R , Tikkinen , K A O , Akl , E A , Gomaa , H A , Mustafa , R A , Agarwal , A , Carpenter , C R , Zhang , Y , Jorge , E C , Almeida , R A M B , do Nascimento Junior , P , Doles , J V P , Mustafa , A A , Sadeghirad , B , Lopes , L C , Bergamaschi , C C , Suzumura , E A , Cardoso , M M A , Corrente , J E , Stone , S B , Schunemann , H J & Guyatt , G H 2017 , ' Systematic survey of randomized trials evaluating the impact of alternative diagnostic strategies on patient-important outcomes ' , Journal of Clinical Epidemiology , vol. 84 , pp. 61-69 . https://doi.org/10.1016/j.jclinepi.2016.12.009

Title: Systematic survey of randomized trials evaluating the impact of alternative diagnostic strategies on patient-important outcomes
Author: El Dib, Regina; Tikkinen, Kari A. O.; Akl, Elie A.; Gomaa, Huda A.; Mustafa, Reem A.; Agarwal, Arnav; Carpenter, Christopher R.; Zhang, Yuchen; Jorge, Eliane C.; Almeida, Ricardo A. M. B.; do Nascimento Junior, Paulo; Doles, Joao Vitor P.; Mustafa, Ahmad A.; Sadeghirad, Behnam; Lopes, Luciane C.; Bergamaschi, Cristiane C.; Suzumura, Erica A.; Cardoso, Marilia M. A.; Corrente, Jose Eduardo; Stone, Samuel B.; Schunemann, Holger J.; Guyatt, Gordon H.
Other contributor: University of Helsinki, Clinicum


Date: 2017-04
Language: eng
Number of pages: 9
Belongs to series: Journal of Clinical Epidemiology
ISSN: 0895-4356
DOI: https://doi.org/10.1016/j.jclinepi.2016.12.009
URI: http://hdl.handle.net/10138/237024
Abstract: Objectives: To provide a perspective on the current practice of randomized clinical trials (RCTs) of diagnostic strategies focusing on patient-important outcomes. Study Design and Setting: We conducted a comprehensive search of MEDLINE and included RCTs published in full-text reports that evaluated alternative diagnostic strategies. 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%. 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. (C) 2017 Elsevier Inc. All rights reserved.
Subject: Clinical trials
Diagnostic techniques and procedures
Accuracy
Alternative diagnostic strategies
Patient outcome
Evidence-based medicine
LUNG-CANCER
DOUBLE-BLIND
ULTRASOUND
ECHOCARDIOGRAPHY
TECHNOLOGIES
MANAGEMENT
FRAMEWORK
UTILITY
WASTE
CARE
3142 Public health care science, environmental and occupational health
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