Comparative accuracy: assessing new tests against existing diagnostic pathways

Patrick M. Bossuyt, Les M. Irwig, Jonathan C. Craig, Paul P. Glasziou

Research output: Contribution to journalArticlepeer-review

326 Citations (Scopus)


Most studies of diagnostic accuracy only compare a test with the reference standard. Is this helpful?

Evaluating diagnostic accuracy is an essential step in the evaluation of medical tests. Yet unlike randomised trials of interventions, which have a control arm, most studies of diagnostic accuracy do not compare the new test with existing tests.

We propose a modified approach to test evaluation, in which the accuracy of new tests is compared with that of existing tests or testing pathways. We argue that knowledge of other features of the new test, such as its availability and invasiveness, can help define how it is likely to be used, and we define three roles of a new test: replacement, triage, and add-on (fig 1).

Knowing the future role of new tests can help in designing studies, in making such studies more efficient, in identifying the best measure of change in accuracy, and in understanding and interpreting the results of studies.
Original languageEnglish
Pages (from-to)1089-1092
Number of pages4
JournalBMJ (International Edition)
Issue number1089
Publication statusPublished - 4 May 2006


  • Diagnostic techniques
  • triage
  • accuracy


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