Systematic reviews and meta-analyses of diagnostic test accuracy

Abstract

Systematic reviews of diagnostic test accuracy summarize the accuracy, e.g. the sensitivity and specificity, of diagnostic tests in a systematic and transparent way. The aim of such a review is to investigate whether a test is sufficiently specific or sensitive to fit its role in practice, to compare the accuracy of two or more diagnostic tests, or to investigate where existing variation in results comes from. The search strategy should be broad and preferably fully reported, to enable readers to assess the completeness of it. Included studies usually have a cross-sectional design in which the tests of interest, ideally both the index test and its comparator, are evaluated against the reference standard. They should be a reflection of the situation that the review question refers to. The quality of included studies is assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 checklist, containing items such as a consecutive and all-inclusive patient selection process, blinding of index test and reference standard assessment, a valid reference standard, and complete verification of all included participants. Studies recruiting cases separately from (healthy) controls are regarded as bearing a high risk of bias. For meta-analysis, the bivariate model or the hierarchical summary receiver operating characteristic model is used. These models take into account potential threshold effects and the correlation between sensitivity and specificity. They also allow addition of covariates for investigatation of potential sources of heterogeneity. Finally, the results from the meta-analyses should be explained and interpreted for the reader, to be well understood.

Diagnostic Accuracy of Rapid Antigen Detection Tests for Respiratory Syncytial Virus Infection: Systematic Review and Meta-analysis

“…Publication bias, the phenomenon of favorable results being published more frequently than negative results, has also been hypothesized to contribute to associations between industry sponsorship and study outcomes (104). We could not formally assess publication bias because the methods typically employed for its detection are not reliable when used with diagnosticaccuracy data (27).…”

“…Data were extracted to construct two-bytwo tables, which were used to calculate the sensitivity and specificity of the rapid tests in each study. The sensitivity and specificity estimates were pooled across studies using a bivariate random-effects regression model (27). The bivariate model takes into consideration the potential tradeoff between sensitivity and specificity by incorporating this negative correlation into the analysis.…”

“…The bivariate model takes into consideration the potential tradeoff between sensitivity and specificity by incorporating this negative correlation into the analysis. Since heterogeneity is usually expected in metaanalysis of accuracy diagnostic studies, a random-effects model is generally preferred (27). The model was also used to draw a summary receiver operating curve plot to graphically depict each study's sensitivity and specificity, along with the summary point.…”

“…Publication bias, the phenomenon of favorable results being published more frequently than negative results, has also been hypothesized to contribute to associations between industry sponsorship and study outcomes (104). We could not formally assess publication bias because the methods typically employed for its detection are not reliable when used with diagnosticaccuracy data (27).Two novel RADT platforms use automated instruments, the BD Veritor System and the Quidel Sofia Analyser, to read the signal produced by the test strip. These newer-generation RADTs eliminate the potential subjectivity of an operator visualizing and interpreting test results, which can lead to improved assay performance (106).…”

Accuracy of ultrasound to detect thrombosis in pregnancy: A systematic review

“…Systematic reviews and meta-analyses aim to summarize the accuracy of diagnostic tests. 15 We cannot determine other parameters and the accuracy of ultrasonography for DVT in pregnant women is unknown.…”