The STARD statement for reporting diagnostic accuracy studies: application to the history and physical examination.
OBJECTIVE
The Standards for Reporting of Diagnostic Accuracy (STARD) statement provided guidelines for investigators conducting diagnostic accuracy studies. We reviewed each item in the statement for its applicability to clinical examination diagnostic accuracy research, viewing each discrete aspect of the history and physical examination as a diagnostic test.


METHODS
Nonsystematic review of the STARD statement.


METHODS
Two former STARD Group participants and 1 editor of a journal series on clinical examination research reviewed each STARD item. Suggested interpretations and comments were shared to develop consensus.


RESULTS
The STARD Statement applies generally well to clinical examination diagnostic accuracy studies. Three items are the most important for clinical examination diagnostic accuracy studies, and investigators should pay particular attention to their requirements: describe carefully the patient recruitment process, describe participant sampling and address if patients were from a consecutive series, and describe whether the clinicians were masked to the reference standard tests and whether the interpretation of the reference standard test was masked to the clinical examination components or overall clinical impression. The consideration of these and the other STARD items in clinical examination diagnostic research studies would improve the quality of investigations and strengthen conclusions reached by practicing clinicians.


CONCLUSIONS
The STARD statement provides a very useful framework for diagnostic accuracy studies. The group correctly anticipated that there would be nuances applicable to studies of the clinical examination. We offer guidance that should enhance their usefulness to investigators embarking on original studies of a patient's history and physical examination.
Simel
David L
DL
Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705, USA. david.simel@duke.edu
Rennie
Drummond
D
Bossuyt
Patrick M M
PM
D006801:Humans; D008487:Medical History Taking / Q000592:standards*; D010808:Physical Examination / Q000592:standards*; D017410:Practice Guidelines as Topic; D011643:Publishing / Q000592:standards; D012107:Research Design