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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Medical Research Methodology 1/2014

Incorporating quality assessments of primary studies in the conclusions of diagnostic accuracy reviews: a cross-sectional study

Zeitschrift:
BMC Medical Research Methodology > Ausgabe 1/2014
Autoren:
Eleanor A Ochodo, Wynanda A van Enst, Christiana A Naaktgeboren, Joris AH de Groot, Lotty Hooft, Karel GM Moons, Johannes B Reitsma, Patrick M Bossuyt, Mariska MG Leeflang
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2288-14-33) contains supplementary material, which is available to authorized users.

Competing interests

No funding was received for this project. JR and PB were involved in the development of both the original and revised QUADAS tool. KGM and ML were involved in the development of the revised QUADAS tool.

Authors’ contribution

Design of study: EO, WE, CN, LH, JG, JR, KGM, PB, ML. Data collection: EO, WE, CN, LH, JG, ML, PB. Data analysis: EO, ML. Data interpretation: EO, WE, CN, LH, JG, JR, KGM, PB, ML. Drafting of manuscript: EO, WE, CN, LH, JG, JR, KGM, PB, ML. Final approval of manuscript: EO, WE, CN, LH, JG, JR, KGM, PB, ML.

Abstract

Background

Drawing conclusions from systematic reviews of test accuracy studies without considering the methodological quality (risk of bias) of included studies may lead to unwarranted optimism about the value of the test(s) under study. We sought to identify to what extent the results of quality assessment of included studies are incorporated in the conclusions of diagnostic accuracy reviews.

Methods

We searched MEDLINE and EMBASE for test accuracy reviews published between May and September 2012. We examined the abstracts and main texts of these reviews to see whether and how the results of quality assessment were linked to the accuracy estimates when drawing conclusions.

Results

We included 65 reviews of which 53 contained a meta-analysis. Sixty articles (92%) had formally assessed the methodological quality of included studies, most often using the original QUADAS tool (n = 44, 68%). Quality assessment was mentioned in 28 abstracts (43%); with a majority (n = 21) mentioning it in the methods section. In only 5 abstracts (8%) were results of quality assessment incorporated in the conclusions. Thirteen reviews (20%) presented results of quality assessment in the main text only, without further discussion. Forty-seven reviews (72%) discussed results of quality assessment; the most frequent form was as limitations in assessing quality (n = 28). Only 6 reviews (9%) further linked the results of quality assessment to their conclusions, 3 of which did not conduct a meta-analysis due to limitations in the quality of included studies. In the reviews with a meta-analysis, 19 (36%) incorporated quality in the analysis. Eight reported significant effects of quality on the pooled estimates; in none of them these effects were factored in the conclusions.

Conclusion

While almost all recent diagnostic accuracy reviews evaluate the quality of included studies, very few consider results of quality assessment when drawing conclusions. The practice of reporting systematic reviews of test accuracy should improve if readers not only want to be informed about the limitations in the available evidence, but also on the associated implications for the performance of the evaluated tests.
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