%0 Journal Article
%T La concordancia entre dos tests cl¨ªnicos para casos binarios: problemas y soluci¨®n Agreement between two clinical tests in binary cases: problems and solution
%A Juan Carlos Azzimonti Renzo
%J Acta bioqu£¿-mica cl£¿-nica latinoamericana
%D 2005
%I Federaci¨®n Bioqu¨ªmica de la Provincia de Buenos Aires
%X Este informe puede ser considerado como un recurso en el an¨¢lisis de concordancia entre tests cl¨ªnicos, observadores, tasas, jueces o expertos. Cuando no se puedan obtener los resultados verdaderos de dos tests cl¨ªnicos, la diferencia entre ellos puede ser reflejada estudiando la concordancia que tienen entre s¨ª. Los m¨¦todos estad¨ªsticos dise ados para hacer este tipo de estudio no son suficientes para decidir si hay concordancia, pues presentan problemas o paradojas desde un punto de vista cl¨ªnico. La soluci¨®n de estos problemas se muestra usando el m¨¦todo de visi¨®n dual. La concordancia general es una dualidad y necesita ser estudiada en dos etapas. En la primera etapa se propone una condici¨®n para la aceptaci¨®n de la concordancia: ambos m¨¦todos deben tener la misma sensibilidad y especificidad. Pero como esto no es suficiente, en la segunda etapa se propone otra condici¨®n: el nivel de concordancia encontrado debe ser mayor o igual a un valor cl¨ªnico definido por los cl¨ªnicos. Cuando ambas etapas muestren resultados satisfactorios, el nuevo m¨¦todo puede reemplazar al m¨¦todo viejo. As¨ª se muestra que la concordancia estad¨ªstica no es lo mismo que la concordancia cl¨ªnica. This report can be considered a resource for the analysis of agreement among clinical tests, observers, judges or experts. When the true results of two clinical tests cannot be obtained, the difference between them can be reflected by studying their agreement. Normal statistical procedures tackling this are not enough to decide whether there is agreement, because they show problems or paradoxes from the clinical viewpoint. The solution to these problems is introduced by using the dual vision method. The overall agreement is a duality, and needs to be studied in two steps. In the tackling this are not enough to decide whether there is agreement, because they show problems or paradoxes from the clinical viewpoint. The solution to these problems is introduced by using the dual vision method. The overall agreement is a duality, and needs to be studied in two steps. In the first step, a condition for the acceptance of the agreement is proposed: both methods need to have the same nosologic sensitivity and specificity. But since this is not enough, another condition is proposed in the second step: the level of agreement should be greater than a critical value defined by the clinicians. When both steps show satisfactory results, the new method can replace the old one. In this way, it is showed that statistical agreement is not the same as clinical agreement.
%K m¨¦todo de visi¨®n dual
%K concordancia cl¨ªnica
%K concordancia estad¨ªstica
%K tabla de concordancia
%K tabla diagn¨®stica
%K nivel de concordancia
%K sensibilidad
%K especificidad
%K dual vision method
%K Clinical agreement
%K Statistical agreement
%K Agreement table
%K Diagnostic Table
%K Level of agreement
%K sensitivity
%K specificity
%U http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0325-29572005000400004