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In medicine
Medicine

Medicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, gold standard test refers to a diagnostic test or benchmark that is regarded as definitive.

This can refer to diagnosing a disease process, or the criteria by which scientific evidence is evaluated. For example, in resuscitation research, the "gold standard" test of a medication or procedure is whether or not it leads to an increase in the number of neurologically intact survivors that walk out of the hospital.






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In medicine
Medicine

Medicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, gold standard test refers to a diagnostic test or benchmark that is regarded as definitive.

This can refer to diagnosing a disease process, or the criteria by which scientific evidence is evaluated. For example, in resuscitation research, the "gold standard" test of a medication or procedure is whether or not it leads to an increase in the number of neurologically intact survivors that walk out of the hospital. Other types of medical research might regard a significant decrease in 30-day mortality as the gold standard.

The AMA Style Guide prefers the phrase Criterion Standard instead of "gold standard", and many medical journals now mandate this usage in their instructions for contributors. For instance, Archives of Physical Medicine and Rehabilitation specifies this usage.

A hypothetical ideal "gold standard" test has a sensitivity, or statistical power
Statistical power

The power of aStatistical hypothesis testing is the probability that the test will reject a false null hypothesis . As power increases, the chances of a Type II error decrease....
, of 100% (it identifies all individuals with a disease process; it does not have any false-negative results) and a specificity of 100% (it does not falsely identify someone with a condition that does not have the condition; it does not have any false-positive results). In practice, there are no ideal "gold standard" tests.

Because tests can be incorrect (either a false-negative
Type I and type II errors

In statistics, the terms Type I error and type II error are used to describe possible errors made in a statistical decision process. In 1928, Jerzy Neyman and Egon Pearson , both eminent statisticians, discussed the problems associated with "deciding whether or not a particular sample may be judged as likely to have been randomly dr...
 or a false-positive
Type I and type II errors

In statistics, the terms Type I error and type II error are used to describe possible errors made in a statistical decision process. In 1928, Jerzy Neyman and Egon Pearson , both eminent statisticians, discussed the problems associated with "deciding whether or not a particular sample may be judged as likely to have been randomly dr...
 result), results should be interpreted in the context of the history, physical findings, and other test results in the individual that is being tested. It is within this context that the sensitivity and specificity of the "gold standard" test is determined.

Quite often the "gold standard" test is not the test performed in a particular individual. In fact, many "gold standard" tests are not performed in the clinical practice of medicine at all. This is because the "gold standard" test may be difficult to perform or may be impossible to perform on a living person (i.e. the test is performed as part of an autopsy
Autopsy

An autopsy, also known as a post-mortem examination, necropsy , autopsia cadaverum, or obduction, is a medical procedure that consists of a thorough examination of a Dead body to determine the cause and manner of death and to evaluate any disease or injury that may be present....
), or may take too long for the results of the test to be available to be clinically useful.

As new diagnostic methods become available, the "gold standard" test may change over time. For instance, for the diagnosis of aortic dissection
Aortic dissection

Aortic dissection is a tear in the wall of the aorta that causes blood to flow between the layers of the wall of the aorta and force the layers apart....
, the "gold standard" test used to be the aortogram, which had a sensitivity as low as 83% and a specificity as low as 87%. Since the advancements of magnetic resonance imaging
Magnetic resonance imaging

GaneshMagnetic resonance imaging , or nuclear magnetic resonance imaging , is primarily a medical imaging technique most commonly used in radiology to visualize the structure and function of the body....
, the magnetic resonance angiogram (MRA) has become the new "gold standard" test for aortic dissection, with a sensitivity of 95% and a specificity of 92%. Before widespread acceptance of any new test, the former test retains its status as the "gold standard."