The spectrum effect in tests for risk prediction, screening, and diagnosis

Juliet A Usher-Smith; Stephen J Sharp; Simon J Griffin

doi:10.1136/bmj.i3139

The spectrum effect in tests for risk prediction, screening, and diagnosis

BMJ. 2016 Jun 22:353:i3139. doi: 10.1136/bmj.i3139.

Authors

Juliet A Usher-Smith¹, Stephen J Sharp², Simon J Griffin³

Affiliations

¹ The Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Cambridge, CB1 8RN, UK jau20@medschl.cam.ac.uk.
² MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK.
³ The Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Cambridge, CB1 8RN, UK MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK.

Abstract

The spectrum effect describes the variation between settings in performance of tests used to predict, screen for, and diagnose disease. In particular, the predictive use of a test may be different when it is applied in a general population rather than in the study sample in which it was first developed. This article discusses the impact of the spectrum effect on measures of test performance, and its implications for the development, evaluation, application, and implementation of such tests.

MeSH terms

Bias
Diagnostic Techniques and Procedures / standards*
Humans
Likelihood Functions*
Mass Screening
Predictive Value of Tests
Prevalence
Risk Assessment
Risk Factors
Sensitivity and Specificity*

Abstract

MeSH terms

Grants and funding