title: When the value of gold is zero.
abstract: This manuscript presents the concerns around the increasingly common problem of not having readily available or useful "gold standard" measurements. This issue is particularly important in critical care where many measurements used in decision making are surrogates of what we would truly wish to use. However, the question is broad, important and applicable in many other areas.In particular, a gold standard measurement often exists, but is not clinically (or ethically in some cases) feasible. The question is how does one even begin to develop new measurements or surrogates if one has no gold standard to compare with?We raise this issue concisely with a specific example from mechanical ventilation, a core bread and butter therapy in critical care that is also a leading cause of length of stay and cost of care. Our proposed solution centers around a hierarchical validation approach that we believe would ameliorate ethics issues around radiation exposure that make current gold standard measures clinically infeasible, and thus provide a pathway to create a (new) gold standard.
authors: J Geoffrey
authors: JG
authors: Chase
authors: Knut
authors: K
authors: Moeller
authors: Geoffrey M
authors: GM
authors: Shaw
authors: Christoph
authors: C
authors: Schranz
authors: Yeong Shiong
authors: YS
authors: Chiew
authors: GIGA-Cardiovascular Sciences, University of Liege, 4000 Liege, Belgium. tdesaive@ulg.ac.be.
authors: Thomas
authors: T
authors: Desaive
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic; D016638:Critical Illness / Q000628:therapy*; D003657:Decision Making; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D011874:Radiometry; D012121:Respiration, Artificial / Q000191:economics / Q000295:instrumentation*; D014055:Tomography, Emission-Computed / Q000191:economics / Q000941:ethics* / Q000706:statistics & numerical data; D054928:Validation Studies as Topic