title: Retrospective classification of prostate-specific antigen tests: differentiating screening from diagnostic clinical encounters.
abstract: To assess the validity of retrospective medical chart review as a method of classifying prostate-specific antigen (PSA) tests as screening or diagnostic services, we reviewed PSA tests ordered at a university hospital (n = 95). PSA tests were reviewed by four raters: medicine resident (RES), oncologist (ONC), urologist (UR), medicine attending (GM)-and the physician who ordered the PSA test (ATTEND) using predefined standardized criteria. Agreement rates by individual rater and ATTEND were 0.79 (GM), 0.80 (ONC), 0.74 (UR), 0.83 (RES), for a composite percent agreement of 0.79. ATTEND incorrectly classified seven tests; exclusion of these tests raised agreement rates to 0.86 (GM), 0.86 (ONC), 0.80 (UR), 0.90 (RES), for a group composite percent agreement of 0.86. Of note, two raters had higher agreement rates when evaluating screening PSA tests than when evaluating diagnostic PSA tests. Standardized criteria applied to medical charts provide a valid method of retrospectively classifying PSA tests.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA. pgodley@med.unc.edu
authors.forename: P A
authors.initials: PA
authors.lastname: Godley
authors.forename: S S
authors.initials: SS
authors.lastname: Rathore
authors.forename: A V
authors.initials: AV
authors.lastname: Kshirsagar
authors.forename: M A
authors.initials: MA
authors.lastname: Amamoo
authors.forename: M J
authors.initials: MJ
authors.lastname: Schell
authors.forename: J
authors.initials: J
authors.lastname: Freeman
authors.forename: R P
authors.initials: RP
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups / Q000592:standards*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008499:Medical Records; D008875:Middle Aged; D009657:North Carolina; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen