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Chapter 12: systematic review of prognostic tests.

Thomas S Rector¹, Brent C Taylor, Timothy J Wilt

¹Minneapolis Veterans Affairs Health Care System and School of Medicine, University of Minnesota, One Veterans Drive,Minneapolis, MN 55905, USA. Thomas.rector@va.gov

Journal of General Internal Medicine

|June 1, 2012

Summary

Systematic reviews can assess new biological markers for predicting disease progression and improving patient treatment decisions. These reviews guide the effective use of prognostic tests for accurate outcome predictions.

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Area of Science:

Biomedical research
Clinical epidemiology
Medical diagnostics

Background:

New biological markers are emerging as predictors for disease progression and adverse events in patients with existing conditions.
Systematic reviews are crucial for evaluating the evidence supporting these biomarkers as prognostic tests.
Current review methods for diagnostic tests may not fully address the unique aspects of prognostic tests.

Purpose of the Study:

To provide guidance for conducting systematic reviews of prognostic tests.
To define key questions and frameworks for reviewing prognostic test evidence.
To improve the accuracy of patient outcome predictions and treatment decisions.

Main Methods:

Framework development for systematic reviews of prognostic tests based on their proposed use.
Focus on outcome probabilities and risk stratification for review and meta-analysis.
Utilizing reclassification tables to assess the impact of prognostic tests on patient categorization.

Main Results:

Systematic reviews are essential to determine if biomarkers can accurately stratify patients into prognostic groups.
Review methods should prioritize statistics relevant to prognostic accuracy and clinical utility.
Reclassification tables are valuable for understanding how prognostic tests influence treatment decisions.

Conclusions:

Conducting systematic reviews of prognostic tests requires a tailored approach focusing on patient outcomes and risk prediction.
Effective reviews can guide the development and implementation of new prognostic tests.
The ultimate goal is to enhance clinical decision-making and improve patient care through accurate prognostic assessment.