Abstract：
OBJECTIVE: To evaluate the strength of the evidence for, and the extent of, overdiagnosis in noncancer conditions.
METHODS: We systematically searched for studies investigating overdiagnosis in noncancer conditions. Using the \'Fair Umpire\' framework to assess the evidence that cases diagnosed by one diagnostic strategy but not by another may be overdiagnosed, two reviewers independently identified whether a Fair Umpire-a disease-specific clinical outcome, a test result or risk factor that can determine whether an additional case does or does not have disease-was present. Disease-specific clinical outcomes provide the strongest evidence for overdiagnosis, follow-up or concurrent tests provide weaker evidence, and risk factors provide only weak evidence. Studies without a Fair Umpire provide the weakest evidence of overdiagnosis.
RESULTS: Of 132 studies, 47 (36%) did not include a Fair Umpire to adjudicate additional diagnoses. When present, the most common Umpire was a single test or risk factor (32% of studies), with disease-specific clinical outcome Umpires used in only 21% of studies. Estimates of overdiagnosis included 43-45% of screen-detected acute abdominal aneurysms, 54% of cases of acute kidney injury, and 77% of cases of oligohydramnios in pregnancy.
CONCLUSIONS: Much of the current evidence for overdiagnosis in noncancer conditions is weak. Application of the framework can guide development of robust studies to detect and estimate overdiagnosis in noncancer conditions, ultimately informing evidence-based policies to reduce it.
METHODS: We systematically searched for studies investigating overdiagnosis in noncancer conditions. Using the \'Fair Umpire\' framework to assess the evidence that cases diagnosed by one diagnostic strategy but not by another may be overdiagnosed, two reviewers independently identified whether a Fair Umpire-a disease-specific clinical outcome, a test result or risk factor that can determine whether an additional case does or does not have disease-was present. Disease-specific clinical outcomes provide the strongest evidence for overdiagnosis, follow-up or concurrent tests provide weaker evidence, and risk factors provide only weak evidence. Studies without a Fair Umpire provide the weakest evidence of overdiagnosis.
RESULTS: Of 132 studies, 47 (36%) did not include a Fair Umpire to adjudicate additional diagnoses. When present, the most common Umpire was a single test or risk factor (32% of studies), with disease-specific clinical outcome Umpires used in only 21% of studies. Estimates of overdiagnosis included 43-45% of screen-detected acute abdominal aneurysms, 54% of cases of acute kidney injury, and 77% of cases of oligohydramnios in pregnancy.
CONCLUSIONS: Much of the current evidence for overdiagnosis in noncancer conditions is weak. Application of the framework can guide development of robust studies to detect and estimate overdiagnosis in noncancer conditions, ultimately informing evidence-based policies to reduce it.
摘要：
目的：评估证据的强度，以及程度，在非癌症条件下过度诊断。
方法：我们系统地搜索了非癌症患者过度诊断的研究。使用“公平裁判”框架评估由一种诊断策略而不是由另一种诊断策略诊断的病例可能被过度诊断的证据，两名审稿人独立鉴定了公平裁判-疾病特异性临床结果，检测结果或风险因素，可以确定是否有一个额外的病例有或没有疾病存在。特定疾病的临床结果为过度诊断提供了最有力的证据，后续或并行测试提供较弱的证据，和风险因素仅提供微弱的证据。没有公平裁判的研究提供了过度诊断的最薄弱的证据。
结果：在132项研究中，47（36％）没有包括公平裁判来裁定其他诊断。当存在时,最常见的裁判是单一测试或危险因素(32%的研究)，具有疾病特异性临床结果的Umpires仅在21％的研究中使用。过度诊断的估计包括43-45％的屏幕检测到的急性腹动脉瘤，54%的急性肾损伤病例,77％的妊娠羊水过少病例。
结论：目前在非癌症疾病中过度诊断的大部分证据是薄弱的。该框架的应用可以指导稳健研究的发展，以检测和估计非癌症疾病的过度诊断，最终通知循证政策以减少它。
方法：我们系统地搜索了非癌症患者过度诊断的研究。使用“公平裁判”框架评估由一种诊断策略而不是由另一种诊断策略诊断的病例可能被过度诊断的证据，两名审稿人独立鉴定了公平裁判-疾病特异性临床结果，检测结果或风险因素，可以确定是否有一个额外的病例有或没有疾病存在。特定疾病的临床结果为过度诊断提供了最有力的证据，后续或并行测试提供较弱的证据，和风险因素仅提供微弱的证据。没有公平裁判的研究提供了过度诊断的最薄弱的证据。
结果：在132项研究中，47（36％）没有包括公平裁判来裁定其他诊断。当存在时,最常见的裁判是单一测试或危险因素(32%的研究)，具有疾病特异性临床结果的Umpires仅在21％的研究中使用。过度诊断的估计包括43-45％的屏幕检测到的急性腹动脉瘤，54%的急性肾损伤病例,77％的妊娠羊水过少病例。
结论：目前在非癌症疾病中过度诊断的大部分证据是薄弱的。该框架的应用可以指导稳健研究的发展，以检测和估计非癌症疾病的过度诊断，最终通知循证政策以减少它。
