Understanding the Influence of Patient Factors on Accuracy and Decision-Making in a Diagnostic Accuracy Study with Multiple Raters—A Case Study from Dentistry

In diagnostic accuracy studies, the test of interest is typically applied only once in each patient. This paper illustrates some possibilities that arise when diagnoses are carried out by a sufficiently large number of multiple raters. In a dental study, sixty-one examiners were asked to diagnose 49...

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Published inInternational journal of environmental research and public health Vol. 20; no. 3; p. 1781
Main Authors Vach, Kirstin, Schlueter, Nadine, Ganss, Carolina, Vach, Werner
Format Journal Article
LanguageEnglish
Published Switzerland MDPI AG 18.01.2023
MDPI
Subjects
Accuracy
Decision making
Dentistry
Diagnostic tests
Enamel
Humans
Meta-analysis
Patients
Subject specialists
Teeth
Tooth
multiple raters
diagnostic study
dentine
diagnostic difficulty
meta-analysis
accuracy
enamel
perception
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Summary:In diagnostic accuracy studies, the test of interest is typically applied only once in each patient. This paper illustrates some possibilities that arise when diagnoses are carried out by a sufficiently large number of multiple raters. In a dental study, sixty-one examiners were asked to diagnose 49 tooth areas with different grades of tissue loss (minor, moderate, and advanced) to decide whether dentine was exposed (positive status) or not (negative status). The true status was determined by histology (reference). For each tooth, the rate of correct decisions reflecting the difficulty to diagnose this tooth and the positive rate reflecting the perception of the tooth by the raters was computed. Meta-analytical techniques were used to assess the inter-tooth variation and the influence of tooth-specific factors on difficulty or perception, respectively. A huge variation in diagnostic difficulty and perception could be observed. Advanced tissue loss made diagnoses more difficult. The background colour and tissue loss were associated with perception and may hint to cues used by the raters. The use of multiple raters in a diagnostic accuracy study allows detailed investigations which make it possible to obtain further insights into the decision-making process of the raters.
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These authors contributed equally to this work.
ISSN:1660-4601
1661-7827
1660-4601
DOI:10.3390/ijerph20031781