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Introduction to Clinical Diagnosis

  • Giuseppe Biondi-Zoccai
  • Mariangela Peruzzi
  • Simona Mastrangeli
  • Giacomo Frati
Chapter

Abstract

Clinical practice is based on decision-making, with choices stemming from a coherent yet pragmatic modeling process of the actual clinical scenario, and diagnosis a key preamble of any decision. Briefly, diagnosis is the process of identifying the actual cause(s) of a complex maze of pathological signs and symptoms from beginning to late consequences. Diagnosis is however an elusive concept in real-world medical practice, as physicians continue to face uncertainty with pragmatism. Accordingly, different diagnostic levels can be envisioned even for the simplest conditions, such as the common cold or anemia. More specifically, medical diagnosis in a living being requires almost always some approximation and reliance on a reference standard (improperly also called gold standard). Whenever a formal comparison is made between the index test being used and the expected or actual findings from the reference test, a study on the diagnostic accuracy of such index test is generated, relying on the comparative accuracy of the index versus reference test. Yet, in the current era of plural and connected medical practice and research, no single study can be considered final, in terms of perfect and enduring internal and external validity. Facing a plethora of similar studies on the diagnostic test accuracy of a medical test can be very challenging. The only acceptable and constructive approach to such challenge is to compile a qualitative and quantitative collection of such studies and to generate a comprehensive summary. This is exactly the goal of systematic reviews and meta-analyses of diagnostic test accuracy studies.

Keywords

Accuracy Diagnosis Meta-analysis Systematic review 

Notes

Funding/Disclosure

None.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Giuseppe Biondi-Zoccai
    • 1
    • 2
  • Mariangela Peruzzi
    • 1
  • Simona Mastrangeli
    • 3
  • Giacomo Frati
    • 1
    • 2
  1. 1.Department of Medico-Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
  2. 2.Department of AngioCardioNeurologyIRCCS NeuromedPozzilliItaly
  3. 3.Superior School of Advanced StudiesSapienza University of RomeRomeItaly

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