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GOLD STANDARDS IN MEDICAL

FIELD

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All rights reserved 2011
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What is a 'gold standard'?

The term 'gold standard' can be referred to a test or a method. A test which

shows the true status of the patient is termed gold standard. These test are assumed

to have 100% sensitivity and specificity. Diagnostic power of other tests are

evaluated based on the comparison with the gold standard test.When the term

applies to a method or a procedure, a 'gold standard' serves as a basis for evaluation

of other methods.

Gold standard method for estimating resting energy expenditure - indirect

calorimetry

Gold standard investigation for diagnosis of Iron deficiency anemia – Estimation of

serum Ferritin

Gold standard for proving that the life span of red cell is decreased ( useful in

Hemolytic anemia) - Red cell survival study

Gold standard for evaluation of stem cell transplantation therapy - Hemopoietic stem

cell transplantation

Gold standard technique for differentiating allograft rejection and reactivation of

disease after heart transplantation - Endo-myocardial Biopsy

Gold standard investigation for diagnosis of DVT - Contrast venography

Gold standard investigation for diagnosis of acute pharyngitis - Throat culture

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Gold standard investigation for diagnosis of pertussis - Culture of nasopharyngeal

secretions

Gold standard investigation for diagnosis of Otitis externa caused by P. aeruginosa -

Technetium99 bone scan

Gold standard investigation for diagnosis of Acoustic Neuroma – Gadolinium MRI

Gold standard investigation for diagnosis of Shigella infection - isolation and

identification of pathogen from fecal material

Gold standard investigation for diagnosis of Tuberculous meningitis - Culture of

CSF

Gold standard investigation for diagnosis of HSV Encephalitis - Brain biopsy (CSF

PCR largely replaced brain biopsy in recent times)

Gold standard investigation for diagnosis of histoplasmosis - Fungal Culture

Gold standard investigation for diagnosis of hypertrophic cardiomypathy and atrial

myxoma - Echocardiogram

Gold standard investigation for imaging heart valves and valve motion abnormalities

- 2D echocardiography

Gold standard investigation for assessment of Myocardial viability (Identification of

ischemic or hibernating myocardium)– PET

Gold standard investigation for assessment of LV mass and volume - MRI

Gold standard method for evaluation of renal arteries and identification of renal

artery lesions - Contrast arteriography

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Gold standard method for evaluation of respiratory gas exchange - ABG

Gold standard investigation for assessment of albuminuria - 24 hr urine collection

Gold standard investigation for diagnosis of PNH (Paroxysmal Nocturnal

Haemoglobinuria) – Flow cytometry

Gold standard investigation for diagnosis of ATTR and other AF mutations - DNA

sequencing

Gold standard method for identifying and quantifying atherosclerosis in cerebral

arteries - x-ray cerebral angiography

Gold standard investigation for evaluating anatomy of arterio venous malformation -

x-ray angiography

Gold standard for diagnosis and classification of ataxia - genotype

Gold standard investigation for diagnosis of of lung infection (Radiotherapy

induced) in a cancer patient - open-lung biopsy

Gold standard medical treatment for symptomatic progressive pulmonary

hypertension – Prostacyclin

Gold standard investigation for diagnosis of PIH – Serum Urea

Gold standard for assessment of visual impairment - Snellen's chart

Gold standard method of treatment of non-castrate metastatic disease - surgical

orchidectomy

Gold standard method for bacterial stain analysis - Pulse-field gel electrophoresis

Gold standard method of treatment of DCIS - Mastectomy

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Gold standard approach for resection of anterior and middle mediastinal masses -

median or lateral thoracotomy

Gold standard method of treatment of Coarctation of aorta - Surgical repair

Gold standard method for evaluation of coronary artery disease - cardiac

Catheterization

Gold standard method for culture of V. cholerae o139 - Conventional culture

methods

Gold standard to determine cut-off titre of widal test for diagnosis of Typhoid fever

– Nested PCR

Gold standard treatment of brucellosis in adults - IM Streptomycin + Doxycyclin

Gold standard investigation for diagnosis of of chronic arterial mesentric ischemia -

angiography

Gold standard method for treatment of chronic ulcerative colitis - Total

proctocolostomy with end ileostomy

Gold standard method for evaluation of imaging modalities for liver tumours -

Intraoperative ultrasonography

Gold standard investigation for diagnosis of common bile duct stones - Endoscopic

cholangiography

Gold standard investigation for measurement of GFR - inulin clearance

Gold standard for treatment of organ confined, muscle invasive, bladder cancer is -

radical cystoprostatectomy in men and anterior pelvic exenteration in woman

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Gold standard for treatment of femoral shaft fractures - reamed locked

intramedullary nailing

Gold standard method in case of difficult intubation - flexible fibreoptic intubation

scope

Gold standard method for diagnosis and treatment of Ventilator Associated

Pneumonia (VAP) - Broncho alveolar lavage

Gold standard treatment of hyperparathyroidism - Surgery

Gold standard investigation to differentiate follicular and papillary carcinoma of

thyroid gland- histology

Gold standard procedure for thymectomy - Trans cervical mediastinoscopy and

surgery

Gold standard for treatment of adrenal tumours - laparoscopic adrenalectomy

Gold standard investigation for diagnosis of breast cancer - mammography

Gold standard method for staging of breast cancer - Axillary lymph node dissection

Gold standard for evaluation of a stable patient with suspected vascular injury -

angiography

Gold standard investigation for diagnosis of GERD - Ambulatory 24 hr PH

monitoring

Gold standard method for treatment of GERD - Laparoccopic Nissens

fundoplication

Gold standard for evaluating cure rate in duodenal ulcer patients – vagotomy

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Gold standard finding for the diagnosis of GI perforation - finding

pneumoperitoneum

Gold standard for diagnosis of Zollinger-Ellison syndrome - Serum gastrin

levels( Most patients have serum gastrin levels above 1000pg/mL)

Gold standard investigation for diagnosis of colonic mucosal disease - colonoscopy

Gold standard investigation for diagnosis of steatorrhoea - timed quantitative stool

fat determination

Gold standard method for treatment of incontinence with an isolated sphincter defect

- overlapping sphincteroplasty

Gold standard investigation for diagnosis and method of management of Acute

arterial occlusion – laparotomy

Gold standard method for confirmation of mesentric arterial occlusion - mesentric

angiography

Gold standard investigation for diagnosis of celiac disease – Small intestine biopsy

Gold standard for identifying choledocholithiasis – ERCP

Gold standard method of treatment of Symptomatic cholelitiasis – Lap

cholecystectomy

Gold standard method for diagnosis of Primary sclerosing cholangitis - ERCP

Gold standard investigation for diagnosis of Hepatitis C – HCV RNA assay

Gold standard test for diagnosis of intraluminal bile duct abnormalities - ERCP

Gold standard method for management of hydatid disease – surgery

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Gold standard for assessing degree of liver injury and fibrosis - Liver Biopsy

Gold standard method for management of blunt hepatic trauma - non-operative

management

Gold standard test for assessment of function of sphincter of oddi – manometry

Gold standaard investigation of diagnosis of Klatskin tumor - Cholangiography

Gold standard investigation for diagnosis of invasive amoebiasis - ELISA

REFERENCES

1. Harrison's principles of Internal Medicine 17th Edition

2. Schwartz's Manual of Surgery 8th Edition

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