Retrospective classification of prostate-specific antigen tests: Differentiating screening from diagnostic clinical encounters

To assess the validity of retrospective medical chart review as a method of classifying prostate-specific antigen (PSA) tests as screening or diagnost ic services. we reviewed PSA tests ordered at a university hospital (n = 95 ). PSA tests were reviewed by four raters: medicine resident (RES), oncolog ist (ONC), urologist (UR), medicine attending (GM)-and the physician who or dered the PSA test (ATTEND) using predefined standardized criteria. Agreeme nt rates by individual rater and ATTEND were 0.79 (GM), 0.80 (ONC), 0.74 (U R), 0.83 (RES), for a composite percent agreement of 0.79. ATTEND incorrect ly classified seven tests: exclusion of these tests raised agreement rates to 0.86 (GM) 0.86 (ONC), 0.80 (UR), 0.90 (RES), for a group composite perce nt agreement of 0.86. Of note, two raters had higher agreement rates when e valuating screening PSA tests than when evaluating diagnostic PSA tests. St andardized criteria applied to medical charts provide a valid method of ret rospectively classifying PSA tests. (C) 2001 Elsevier Science Inc. All righ ts reserved.