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Bench-to-bedside review: The importance of the precision of the reference technique in method comparison studies - with specific reference to the measurement of cardiac output

Cecconi, M; Rhodes, A; Poloniecki, J; Della Rocca, G; Grounds, RM (2009) Bench-to-bedside review: The importance of the precision of the reference technique in method comparison studies - with specific reference to the measurement of cardiac output. CRITICAL CARE, 13 (201). ISSN 1466-609X https://doi.org/10.1186/cc7129
SGUL Authors: Poloniecki, Jan Dominik Cecconi, Maurizio Rhodes, Andrew

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Abstract

Bland-Altman analysis is used for assessing agreement between two measurements of the same clinical variable. In the field of cardiac output monitoring, its results, in terms of bias and limits of agreement, are often difficult to interpret, leading clinicians to use a cutoff of 30% in the percentage error in order to decide whether a new technique may be considered a good alternative. This percentage error of ± 30% arises from the assumption that the commonly used reference technique, intermittent thermodilution, has a precision of ± 20% or less. The combination of two precisions of ± 20% equates to a total error of ± 28.3%, which is commonly rounded up to ± 30%. Thus, finding a percentage error of less than ± 30% should equate to the new tested technique having an error similar to the reference, which therefore should be acceptable. In a worked example in this paper, we discuss the limitations of this approach, in particular in regard to the situation in which the reference technique may be either more or less precise than would normally be expected. This can lead to inappropriate conclusions being drawn from data acquired in validation studies of new monitoring technologies. We conclude that it is not acceptable to present comparison studies quoting percentage error as an acceptability criteria without reporting the precision of the reference technique.

Item Type: Article
Additional Information: © 2009 BioMed Central Ltd. Published under the Creative Commons Attribution License 4.0.
Keywords: Biomedical Research, Cardiac Output, Humans, Monitoring, Physiologic, Point-of-Care Systems, Reference Standards, Reproducibility of Results, Science & Technology, Life Sciences & Biomedicine, Critical Care Medicine, General & Internal Medicine, CRITICAL CARE MEDICINE, PULSE CONTOUR ANALYSIS, PULMONARY-ARTERY THERMODILUTION, WAVE-FORM ANALYSIS, ESOPHAGEAL DOPPLER, SURGERY, AGREEMENT, SYSTEM, TRIAL, Humans, Cardiac Output, Monitoring, Physiologic, Reproducibility of Results, Reference Standards, Point-of-Care Systems, Emergency & Critical Care Medicine, 11 Medical And Health Sciences
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: CRITICAL CARE
ISSN: 1466-609X
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Dates:
DateEvent
13 January 2009Published
Web of Science ID: WOS:000264351600050
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URI: http://openaccess.sgul.ac.uk/id/eprint/107197
Publisher's version: https://doi.org/10.1186/cc7129

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