Systematic reviews of diagnostic research. Considerations about assessment and incorporation of methodological quality

The aim of this paper is to provide a theoretical background for performing and reading systematic reviews of diagnostic studies. We first discuss items for assessment of methodological quality in diagnostic studies and then present methods on how to incorporate these quality measures in systematic reviews. The items of internal validity determine whether the presented results of the individual studies are unbiased and can be trusted. Items of external validity determine to what extent the results are applicable outside the population in which the study was performed. The issues concern the adequacy of the study population, the performance and interpretation of the diagnostic tests and the presentation of the results. Several methods exist for incorporation of issues of methodological quality into systematic reviews, such as subgroup analyses, meta-regression analysis, and methodological scores. Publications of diagnostic studies should provide sufficient information to enable assessment of the methodological quality. Furthermore, publication of results of subgroup analyses should be promoted. Methodological criteria lists might help to improve the quality of systematic reviews of diagnostic research. With the items of methodological quality in mind the general practitioner might be better equipped to critically read and interpret diagnostic reviews.

[1]  Gordon H. Guyatt,et al.  Users' Guides to the Medical Literature: III. How to Use an Article About a Diagnostic Test A. Are the Results of the Study Valid? , 1994 .

[2]  A R Feinstein,et al.  Use of methodological standards in diagnostic test research. Getting better but still not good. , 1995, JAMA.

[3]  F. Harrell,et al.  Rethinking sensitivity and specificity. , 1987, The American journal of cardiology.

[4]  Diagnostic prediction rules: principles, requirements and pitfalls. , 1995 .

[5]  L. Bouter,et al.  On the Accuracy of History, Physical Examination, and Erythrocyte Sedimentation Rate in Diagnosing Low Back Pain in General Practice: A Criteria‐Based Review of the Literature , 1995, Spine.

[6]  R J Panzer,et al.  Workup Bias in Prediction Research , 1987, Medical decision making : an international journal of the Society for Medical Decision Making.

[7]  P. Bossuyt,et al.  Empirical evidence of design-related bias in studies of diagnostic tests. , 1999, JAMA.

[8]  S. Sheps,et al.  The assessment of diagnostic tests. A survey of current medical research. , 1984, JAMA.

[9]  G. Guyatt,et al.  Users' guides to the medical literature. , 1993, JAMA.

[10]  G. Diamond,et al.  Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. , 1979, The New England journal of medicine.

[11]  M. Egger,et al.  The hazards of scoring the quality of clinical trials for meta-analysis. , 1999, JAMA.

[12]  Diederick E. Grobbee,et al.  Limitations of Sensitivity, Specificity, Likelihood Ratio, and Bayes' Theorem in Assessing Diagnostic Probabilities: A Clinical Example , 1997, Epidemiology.

[13]  G. Guyatt,et al.  Users' Guides to the Medical Literature: III. How to Use an Article About a Diagnostic Test: B. What Are the Results and Will They Help Me In Caring for My Patients? , 1994 .

[14]  Y. T. van der Schouw,et al.  Guidelines for the Assessment of New Diagnostic Tests , 1995, Investigative radiology.

[15]  O. Miettinen,et al.  Foundations of medical diagnosis: what actually are the parameters involved in Bayes' theorem? , 1994, Statistics in medicine.

[16]  A. Feinstein,et al.  Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. , 1978, The New England journal of medicine.

[17]  D. Sackett,et al.  The Ends of Human Life: Medical Ethics in a Liberal Polity , 1992, Annals of Internal Medicine.

[18]  P. Leffers,et al.  The influence of referral patterns on the characteristics of diagnostic tests. , 1992, Journal of clinical epidemiology.

[19]  J. Knottnerus,et al.  Non-acute abdominal complaints in general practice: diagnostic value of signs and symptoms. , 1995, The British journal of general practice : the journal of the Royal College of General Practitioners.

[20]  P Glasziou,et al.  Meta-analytic methods for diagnostic test accuracy. , 1995, Journal of clinical epidemiology.

[21]  S Greenland,et al.  Invited commentary: a critical look at some popular meta-analytic methods. , 1994, American journal of epidemiology.

[22]  G. Guyatt,et al.  Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. , 1994, JAMA.

[23]  H. D. de Vet,et al.  The diagnostic value of digital rectal examination in primary care screening for prostate cancer: a meta-analysis. , 1999, Family practice.

[24]  G. Dinant,et al.  Medicine based evidence, a prerequisite for evidence based medicine , 1997, BMJ.

[25]  C B Begg,et al.  Biases in the assessment of diagnostic tests. , 1987, Statistics in medicine.

[26]  Trisha Greenhalgh,et al.  How to read a paper: Papers that report diagnostic or screening tests , 1997, BMJ.