Systematic survey of randomized trials evaluating the impact of alternative diagnostic strategies on patient-important outcomes

J Clin Epidemiol. 2017 Apr;84:61-69. doi: 10.1016/j.jclinepi.2016.12.009. Epub 2017 Jan 4.


Objectives: To provide a perspective on the current practice of randomized clinical trials (RCTs) of diagnostic strategies focusing on patient-important outcomes.

Study design and setting: We conducted a comprehensive search of MEDLINE and included RCTs published in full-text reports that evaluated alternative diagnostic strategies.

Results: Of 56,912 unique citations, we sampled 7,500 and included 103 eligible RCTs, therefore suggesting that MEDLINE includes approximately 781 diagnostic RCTs. The 103 eligible trials reported on: mortality (n = 41; 39.8%); morbidities (n = 63; 61.2%); symptoms/quality of life/functional status (n = 14; 13.6%); and on composite end points (n = 10; 9.7%). Of the studies that reported statistically significant results (n = 12; 11.6%), we judged 7 (58.3%) as at low risk of bias with respect to missing outcome data and 4 (33.3%) as at low risk of bias regarding blinding. Of the 41 RCTs that reported on mortality, only one (2.4%) reported statistically significant results. Of 63 RCTs addressing morbidity outcomes, 11 (17.5%) reported statistically significant results, all of which reported relative effects of greater than 20%.

Conclusion: RCTs of diagnostic tests are not uncommon, and sometimes suggest benefits on patient-important outcomes but often suffer from limitations in sample size and conduct.

Keywords: Accuracy; Alternative diagnostic strategies; Clinical trials; Diagnostic techniques and procedures; Evidence-based medicine; Patient outcome.

Publication types

  • Review

MeSH terms

  • Diagnostic Tests, Routine / statistics & numerical data*
  • Humans
  • Patient Outcome Assessment*
  • Randomized Controlled Trials as Topic / statistics & numerical data*