Did the results of the test being evaluated influence the decision to perform the reference standard?
No. The reference standard was applied to all patients (deaths). The diagnostic techniques were performed antemortem. The results of the antemortem cultures undoubtedly influenced antibiotic therapy and possibly influenced the patient outcome (death or survival). This would affect the population subjected to the reference standard (the spectrum of dead children). Furthermore, the antibiotic choices must have had an impact on the findings of the reference standard, because only 2 BAL cultures and only 4 PBB cultures were identical to the postmortem cultures.
