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Systematic Review of Prognostic Tests.


In: Chang SM1, Matchar DB2, Smetana GW3, Umscheid CA4, editors.


Methods Guide for Medical Test Reviews [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jun. Chapter 12.
AHRQ Methods for Effective Health Care.

Author information

Duke University
Beth Israel Deaconess Medical Center and Harvard Medical School
University of Pennsylvania
Minneapolis Veterans Affairs Health Care System; School of Medicine, University of Minnesota, Minneapolis, MN


A number of new biological markers are being studied as predictors of disease or adverse medical events among those who already have a disease. Systematic reviews of this growing literature can help determine whether the available evidence supports use of a new biomarker as a prognostic test that can more accurately place patients into different prognostic groups to improve treatment decisions and the accuracy of outcome predictions. Exemplary reviews of prognostic tests are not widely available, and the methods used to review diagnostic tests do not necessarily address the most important questions about prognostic tests that are used to predict the time-dependent likelihood of future patient outcomes. We provide suggestions for those interested in conducting systematic reviews of a prognostic test. The proposed use of a prognostic test should serve as the framework for a systematic review and help define the key questions. The outcome probabilities or level of risk and other characteristics of prognostic groups are the most salient statistics for review and perhaps meta-analysis. Reclassification tables can help determine how a prognostic test affects the classification of patients into different prognostic groups, and hence helps determine their treatment. However, review of studies of the association between a potential prognostic test and patient outcomes would have little impact other than to determine whether further development as a prognostic test might be warranted.

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