The online version of this article (doi:10.1186/1471-2288-14-33) contains supplementary material, which is available to authorized users.
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.
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.
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.
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.
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.
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.
Agency for Healthcare Research and Quality: Methods Guide for Medical Test Reviews. 2012, Rockville, MD: AHRQ Publication No.12-EC017
Higgins JPT, Altman DG, Sterne JAC: Chapter 8: assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. Edited by: Higgins JPT, Green S. 2011, The Cochrane Collaboration
Reitsma J, Rutjes A, Whiting P, Vlassov VV, Leeflang M, Deeks J: Chapter9: assessing methodological quality. Cochrane Handbook for Systematic Reviews of Diagnostic Test Acuracy. Version 1.0.0. Edited by: Deeks J, Bossuyt P, Gatsonis C. 2009, The Cochrane Collaboration
Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Lijmer JG, Moher D, Rennie D, de Vet HC: Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Ann Intern Med. 2003, 138 (1): 40-44. 10.7326/0003-4819-138-1-200301070-00010. CrossRefPubMed
Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Moher D, Rennie D, de Vet HC, Lijmer JG: The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med. 2003, 138 (1): W1-W12. 10.7326/0003-4819-138-1-200301070-00012-w1. CrossRefPubMed
Dahabreh IJ, Chung M, Kitsios GD, Terasawa T, Raman G, Tatsioni A, Tobar A, Lau J, Trikalinos TA, Schimd CH: Methods Research Report. Comprehensive Overview of Methods and Reporting of Meta-Analyses of Test Accuracy. 2012, Agency for Healthcare Research and Quality: AHRQ, Rockville, MD
Atluri S, Singh V, Datta S, Geffert S, Sehgal N, Falco FJE: Diagnostic accuracy of thoracic facet joint nerve blocks: an update of the assessment of evidence. Pain Physician. 2012, 15: e483-e496. PubMed
van Teeffelen AS, Van Der Heijden J, Oei SG, Porath MM, Willekes C, Opmeer B, Mol BW: Accuracy of imaging parameters in the prediction of lethal pulmonary hypoplasia secondary to mid-trimester prelabor rupture of fetal membranes: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2012, 39 (5): 495-499. 10.1002/uog.10047. CrossRefPubMed
Wu L-M, Xu J-R, Ye Y-Q, Lu Q, Hu J-N: The clinical value of diffusion-weighted imaging in combination with T2-weighted imaging in diagnosing prostate carcinoma: a systematic review and meta-analysis. Am J Roentgenol. 2012, 199 (1): 103-110. 10.2214/AJR.11.7634. CrossRef
Macaskill P, Gatsonis C, Deeks JJ, Harbord R, Takwoingi Y: Chapter 10: analysing and presenting results. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Version 1.0. 1. Edited by: Deeks JJ, Bossuyt PM, Gatsonis C. 2010, The Cochrane Collaboration
Brozek JL, Akl EA, Jaeschke R, Lang DM, Bossuyt P, Glasziou P, Helfand M, Ueffing E, Alonso-Coello P, Meerpohl J, Phillips B, Harvath AR, Bousquet J, Guyatt GH, Schünemann HJ: Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies. Allergy. 2009, 64 (8): 1109-1116. 10.1111/j.1398-9995.2009.02083.x. CrossRefPubMed
- Incorporating quality assessments of primary studies in the conclusions of diagnostic accuracy reviews: a cross-sectional study
Eleanor A Ochodo
Wynanda A van Enst
Christiana A Naaktgeboren
Joris AH de Groot
Karel GM Moons
Johannes B Reitsma
Patrick M Bossuyt
Mariska MG Leeflang
- BioMed Central
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