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International Journal of Epidemiology 2005 34(4):949-952; doi:10.1093/ije/dyi012
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2005; all rights reserved.

Methodology

Assessing case definitions in the absence of a diagnostic gold standard

David Coggon1,*, Christopher Martyn1, Keith T Palmer1 and Bradley Evanoff2

1 MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
2 Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, Campus Box 8005, 660 South Euclid Avenue, St. Louis, MO 63110, USA

* Corresponding author. MRC Environmental Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD, UK. E-mail: dnc{at}mrc.soton.ac.uk

Optimal case definition is important in epidemiological research, but can be problematic when no satisfactory gold standard is available. In particular, difficulties arise where the pathology underlying a disorder is unknown or cannot be reliably diagnosed. This problem can be overcome if diagnoses are viewed not necessarily as labels for disease processes, but more generally as a useful method for classifying people for the purpose of preventing or managing illness. With this perspective, the value of a case definition lies in its practical utility in distinguishing groups of people whose illnesses share the same causes or determinants of outcome (including response to treatment). A corollary is that the best-case definition for a disorder may vary according to the purpose for which it is being applied.

Keywords Diagnosis, classification, validity

Accepted 23 November 2004


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