Bootstrap estimation of diagnostic accuracy with patient-clustered data

Acad Radiol. 2000 Jun;7(6):413-9. doi: 10.1016/s1076-6332(00)80381-5.


Rationale and objectives: The purpose of this study was to describe a simple bootstrap approach for estimating sensitivity, specificity, and the area under the receiver operating characteristic curve for multisite test outcome data.

Materials and methods: The performance of bootstrap estimates was evaluated and compared with that of analytic estimates by using a simulation study. Bootstrapping was demonstrated by using data from a previous study comparing two angiographic methods.

Results: Analytic and bootstrap estimates had similar coverage rates for 95% confidence intervals. With many sites per patient, bootstrap estimates had slightly better coverage than analytic estimates. Bootstrap percentile intervals had better coverage than asymptotic normal bootstrap intervals.

Conclusion: Bootstrapping is a useful method of estimating confidence intervals for the area under the receiver operating characteristic curve, sensitivity, and specificity when data are correlated.

Publication types

  • Comparative Study

MeSH terms

  • Angiography / standards
  • Angiography / statistics & numerical data*
  • Area Under Curve*
  • Arterial Occlusive Diseases / diagnosis*
  • Cluster Analysis
  • Computer Simulation
  • Confidence Intervals
  • Humans
  • Magnetic Resonance Angiography / standards
  • Magnetic Resonance Angiography / statistics & numerical data*
  • ROC Curve*