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Studies of diagnostic test accuracy: Partial verification bias and test result-based sampling

Michael A Kohn1

  • 1Epidemiology and Biostatistics, UCSF: University of California San Francisco, CA USA.

Journal of Clinical Epidemiology
|February 6, 2022
PubMed
Abstract

Insights

Partial verification bias in diagnostic test accuracy studies can be avoided by applying the reference standard to all positive index tests and a random sample of negative ones. This method requires adjusting for sampling fractions to accurately estimate test performance.

Area of Science:

  • Medical Diagnostics
  • Biostatistics

Background:

  • Partial verification bias is a challenge in diagnostic test accuracy studies.
  • It arises when a positive index test result influences the application of the reference standard.

Purpose of the Study:

  • To describe alternative sampling frames for diagnostic test accuracy studies.
  • To discuss and provide a method for avoiding partial verification bias.

Main Methods:

  • The study proposes applying the reference standard to all individuals with a positive index test.
  • A random sample of individuals with a negative index test should also receive the reference standard.
  • This approach requires statistical adjustment for the sampling fraction in the test-negative group.

Main Results:

  • This sampling strategy helps to mitigate partial verification bias.
  • Estimating sensitivity and specificity necessitates accounting for the sampling fraction of the negative group.

Conclusions:

  • Careful study design is crucial to avoid bias in diagnostic accuracy assessments.
  • Understanding and addressing partial verification bias ensures more reliable evaluation of diagnostic tests.
Keywords:
Case-control samplingPartial verification biasTest accuracyTest result-based samplingVerification biasWork-up bias

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