Assessing case definitions in the absence of a diagnostic gold standard

Coggon, David, Martyn, Christopher, Palmer, Keith T. and Evanoff, Bradley (2005) Assessing case definitions in the absence of a diagnostic gold standard. International Journal of Epidemiology, 34 (4), 949-952. (doi:10.1093/ije/dyi012).

Record type: Article

Abstract

Optimal case definition is important in epidemiological research, but can be problematic when no satisfactory gold standard is available. In particular, difficulties arise where the pathology underlying a disorder is unknown or cannot be reliably diagnosed. This problem can be overcome if diagnoses are viewed not necessarily as labels for disease processes, but more generally as a useful method for classifying people for the purpose of preventing or managing illness. With this perspective, the value of a case definition lies in its practical utility in distinguishing groups of people whose illnesses share the same causes or determinants of outcome (including response to treatment). A corollary is that the best-case definition for a disorder may vary according to the purpose for which it is being applied.

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