Estimation of sensitivity and specificity of multiple repeated binary tests without a gold standard.

A model for multiple diagnostic tests, applied repeatedly over time on each subject, is proposed; gold standard data are not required. The model is identifiable with as few as three tests, and correlation among tests at each time point in the diseased and nondiseased populations, as well as across time points, is explicitly included. An efficient Markov chain Monte Carlo scheme allows for straightforward posterior inference; sample R code is available in the Supporting Web Materials for this paper. The proposed model is broadly illustrated via simulations and an analysis of scaphoid fracture data from a prospective study. In addition, omnibus tests constructed from individual tests in parallel and serial are considered.