title: Evaluating detection and diagnostic decision support systems for bioterrorism response.
abstract: We evaluated the usefulness of detection systems and diagnostic decision support systems for bioterrorism response. We performed a systematic review by searching relevant databases (e.g., MEDLINE) and Web sites for reports of detection systems and diagnostic decision support systems that could be used during bioterrorism responses. We reviewed over 24,000 citations and identified 55 detection systems and 23 diagnostic decision support systems. Only 35 systems have been evaluated: 4 reported both sensitivity and specificity, 13 were compared to a reference standard, and 31 were evaluated for their timeliness. Most evaluations of detection systems and some evaluations of diagnostic systems for bioterrorism responses are critically deficient. Because false-positive and false-negative rates are unknown for most systems, decision making on the basis of these systems is seriously compromised. We describe a framework for the design of future evaluations of such systems.
authors.affiliation: University of California San Francisco-Stanford Evidence-based Practice Center, Stanford, California, USA. bravata@healthpolicy.stanford.edu
authors.forename: Dena M
authors.initials: DM
authors.lastname: Bravata
authors.forename: Vandana
authors.initials: V
authors.lastname: Sundaram
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: McDonald
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Smith
authors.forename: Herbert
authors.initials: H
authors.lastname: Szeto
authors.forename: Mark D
authors.initials: MD
authors.lastname: Schleinitz
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
mesh_terms: D023482:Bioterrorism; D003661:Decision Support Techniques; D019937:Diagnostic Techniques and Procedures; D006801:Humans; D012372:ROC Curve