We want to have confidence that we can reliably predict that a patient has a high chance of having or not having a disease. Our subsequent decisions about treating, not treating, or referring depend on the adequacy of our diagnosis. The problem is that there is little evidence to be found at all, and little of that is good news. A succession of stories saying that tests are useless loses impact. Without empirical evidence of bias in study architecture, we are rudderless in the midst of a tidal surge.
Help is at hand.
Two recent publications have begun to lay a little more foundation and to provide a sea-anchor in this turbulent area. This is an important, perhaps seminal paper. More than any other Bandolier has read it explains why new research, indeed, new thinking, is required. It's beautifully written and easy to follow, and is essential reading. A systematic review sought physical signs for differentiating patients for those with COAD from those with normal pulmonary function.