Evaluation of diagnostic accuracy in detecting ordered symptom statuses without a gold standard

Biostatistics. 2011 Jul;12(3):567-81. doi: 10.1093/biostatistics/kxq075. Epub 2011 Jan 5.

Abstract

Our research is motivated by 2 methodological problems in assessing diagnostic accuracy of traditional Chinese medicine (TCM) doctors in detecting a particular symptom whose true status has an ordinal scale and is unknown-imperfect gold standard bias and ordinal scale symptom status. In this paper, we proposed a nonparametric maximum likelihood method for estimating and comparing the accuracy of different doctors in detecting a particular symptom without a gold standard when the true symptom status had an ordered multiple class. In addition, we extended the concept of the area under the receiver operating characteristic curve to a hyper-dimensional overall accuracy for diagnostic accuracy and alternative graphs for displaying a visual result. The simulation studies showed that the proposed method had good performance in terms of bias and mean squared error. Finally, we applied our method to our motivating example on assessing the diagnostic abilities of 5 TCM doctors in detecting symptoms related to Chills disease.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms
  • Computer Simulation
  • Data Interpretation, Statistical*
  • Diagnostic Techniques and Procedures / standards*
  • Humans
  • Likelihood Functions
  • Medicine, Chinese Traditional / methods*
  • Physicians
  • ROC Curve*