Gold standard (test)
In
The meanings may differ between practical medicine and the statistical ideal because, in medicine with some conditions, only an autopsy guarantees diagnostic certainty, thus the gold standard test would be the best one that keeps the patient alive instead of the autopsy. In these cases, even so-called "gold standard" tests require follow-up to confirm or refute the diagnosis.[4]
History
The term 'gold standard' in its current sense in medical research was coined by Rudd in 1979, in reference to the monetary gold standard.[5]
In medicine
"Gold standard" can refer to the criteria by which scientific evidence is evaluated. For example, in resuscitation research, the "gold standard" test of a medication or procedure is whether or not it leads to an increase in the number of neurologically intact survivors that walk out of the hospital.[6] Other types of medical research might regard a significant decrease in 30-day mortality as the gold standard.[citation needed]
The AMA Style Guide has preferred the phrase criterion standard instead of "gold standard." Other journals have also issued mandates in their instructions for contributors. For instance, the Archives of Biological Medicine and Rehabilitation specifies this usage.[7] In practice, however, the uptake of this term by authors, as well as enforcement by editorial staff, is notably poor, at least for AMA journals.[8]
When the criterion is a whole clinical testing procedure it is usually referred to as
A hypothetical ideal "gold standard" test has a
As new diagnostic methods become available, the "gold standard" test may change over time. For instance, for the diagnosis of
Test calibration
Because tests can be incorrect (yielding a false-negative or a false-positive), results should be interpreted in the context of the history, physical findings, and other test results of the individual being tested. It is within this context that the sensitivity and specificity of the "gold standard" test is determined.[citation needed]
When the gold standard is not a perfect one, its
Calibration errors can lead to misdiagnosis.[13][dubious ]
PMID 20692619.. . (December 2023) |
Ambiguity
Sometimes "gold standard test" refers to the best-performing test available. In these cases, there is no other criterion against which it can be compared and it is equivalent to a definition. When referring to this meaning, gold standard tests are normally not performed at all. This is because the gold standard test may be difficult to perform or may be impossible to perform on a living person (i.e. the test is performed as part of an autopsy or may take too long for the results of the test to be available to be clinically useful).
Other times, the "gold standard" does not refer to the best-performing test available, but the best available under reasonable conditions. For example, in this sense, an MRI is the gold standard for brain tumor diagnosis, though it is not as good as a biopsy. In this case, the sensitivity and specificity of the gold standard are not 100% and it is said to be an "imperfect gold standard" or "alloyed gold standard".[11]
The term ground truth refers to the underlying absolute state of information; the gold standard strives to represent the ground truth as closely as possible. While the gold standard is the best effort to obtain the truth, ground truth is typically collected by direct observations. In machine learning and information retrieval, "ground truth" is the preferred term even when classifications may be imperfect; the gold standard is assumed to be the ground truth.[citation needed]
Some authors use the term "golden standard". Claassen argues this usage is incorrect, as "golden standard" implies a level of perfection that is unattainable in medical science.[5]
See also
- Evidence-based medicine
- Statistical test
References
- ^ PMID 35695742.
- PMID 20692619.
- PMID 1515860.
- PMID 25694317.
- ^ PMID 16402524.
- ISBN 0-87493-341-2.
- ^ "Guide for Authors". Archives of biological Medicine and Rehabilitation. Elsevier.
- ^ "Criterion Standard - AMA Style Insider". 21 June 2011. Retrieved 2021-05-18.
- PMID 15911545.
- PMID 8666479.
- ^ PMID 9006315.
- PMID 1735144.
- ^ Gallaher MP, Mobley LR, Klee GG, Schryver P (April 2004). The Impact of Calibration Error in Medical Decision Making (PDF) (Report). Washington (DC): National Institute of Standards and Technology.