Comput Math Methods Med - A general latent class model for performance evaluation of diagnostic tests in the absence of a gold standard: an application to Chagas disease.

Tópicos

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{ risk(3053) factor(974) diseas(938) }
{ general(901) number(790) one(736) }
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{ method(2212) result(1239) propos(1039) }
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{ age(1611) year(1155) adult(843) }
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Resumo

We propose a new general Bayesian latent class model for evaluation of the performance of multiple diagnostic tests in situations in which no gold standard test exists based on a computationally intensive approach. The modeling represents an interesting and suitable alternative to models with complex structures that involve the general case of several conditionally independent diagnostic tests, covariates, and strata with different disease prevalences. The technique of stratifying the population according to different disease prevalence rates does not add further marked complexity to the modeling, but it makes the model more flexible and interpretable. To illustrate the general model proposed, we evaluate the performance of six diagnostic screening tests for Chagas disease considering some epidemiological variables. Serology at the time of donation (negative, positive, inconclusive) was considered as a factor of stratification in the model. The general model with stratification of the population performed better in comparison with its concurrents without stratification. The group formed by the testing laboratory Biomanguinhos FIOCRUZ-kit (c-ELISA and rec-ELISA) is the best option in the confirmation process by presenting false-negative rate of 0.0002% from the serial scheme. We are 100% sure that the donor is healthy when these two tests have negative results and he is chagasic when they have positive results.

Resumo Limpo

propos new general bayesian latent class model evalu perform multipl diagnost test situat gold standard test exist base comput intens approach model repres interest suitabl altern model complex structur involv general case sever condit independ diagnost test covari strata differ diseas preval techniqu stratifi popul accord differ diseas preval rate add mark complex model make model flexibl interpret illustr general model propos evalu perform six diagnost screen test chaga diseas consid epidemiolog variabl serolog time donat negat posit inconclus consid factor stratif model general model stratif popul perform better comparison concurr without stratif group form test laboratori biomanguinho fiocruzkit celisa recelisa best option confirm process present falseneg rate serial scheme sure donor healthi two test negat result chagas posit result

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