NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Comprehensive Overview of Methods and Reporting of Meta-Analyses of Test Accuracy
Methods Research Reports
Investigators: Issa J Dahabreh, MD, MS, Mei Chung, PhD, MPH, Georgios D Kitsios, MD, PhD, MS, Teruhiko Terasawa, MD, PhD, Gowri Raman, MD, MS, Athina Tatsioni, MD, PhD, Annette Tobar, MD, MS, Joseph Lau, MD, Thomas A Trikalinos, MD, PhD, and Christopher H Schmid, PhD.
Author Information and AffiliationsStructured Abstract
Background:
Medical tests play a critical role in disease screening, diagnosis, and prediction of future outcomes. Meta-analyses of diagnostic or predictive test accuracy are increasingly performed and the relevant methods are continuously evolving.
Methods:
We identified systematic reviews including quantitative synthesis (meta-analysis) of test accuracy for diagnostic or predictive medical tests through MEDLINE searches (1966 to December 2009) and perusal of reference lists of eligible articles and relevant reviews. We extracted information on topics and test types covered, methods for literature synthesis and quality assessment, availability of data, and statistical analyses performed.
Results:
Our searches retrieved 1,225 potentially eligible reviews of which 760 (published from 1987 to 2009) were finally considered eligible for inclusion. Eligible reviews included a median of 18 primary studies and typically examined a single index test against a single reference standard. The number of publications increased per calendar year (P < 0.001). Most meta-analyses pertained to cardiovascular disease (21 percent) and oncology (25 percent); the most common test categories were imaging (44 percent) and biomarker tests (28 percent). Meta-analyses used multiple electronic databases (62 percent used at least one electronic database in addition to MEDLINE; P for trend over time < 0.001) to identify eligible studies. There was a striking increase in the proportion of systematic reviews that reported assessing verification bias (P for trend < 0.001), spectrum bias (P for trend = 0.007), blinding (P for trend < 0.001), prospective study design (P for trend < 0.001), or consecutive patient recruitment (P for trend < 0.001), over time. Improvements were associated with reporting of using quality-item checklists to guide assessment of methodological quality. In statistical analyses, sensitivity (in 77 percent), specificity (in 74 percent) and diagnostic/predictive odds ratios (in 34 percent) were the most commonly used metrics. Heterogeneity tests were used in 58 percent, and subgroup or regression analyses were used in 57 percent of meta-analyses. Random effects models were employed in 57 percent of the reviews and increasingly over time (P for trend < 0.001). Theoretically motivated methods that model sensitivity and specificity simultaneously, while accounting for between-study heterogeneity, were used in a minority of reviews (11 percent) but increasingly over time (P for trend < 0.001).
Conclusion:
Meta-analyses of diagnostic or predictive tests are increasingly performed. Over time there have been substantial improvements in the literature review, quality assessment and statistical analysis methods employed. Much of the improvement in quality assessment is associated with the use of quality item checklists. Advanced statistical methods have been increasingly adopted over time but their use still remains limited.
Contents
- Preface
- Background
- Methods
- Results
- Eligible Systematic Reviews
- Literature Review Methods in Reviews of Test Accuracy
- Factors Affecting the Number of Studies Included in Each Review
- Quality Assessment and Use of Checklists
- Statistical Analyses and Presentation of Results in Reviews of Test Accuracy
- Comparison of Reviews in the Five Most Commonly Assessed Medical Fields
- Comparison of Reviews of the Five Most Commonly Assessed Test Categories
- Journal Impact Factor and Citation Count
- Discussion
- References
- Abbreviations
- Appendixes
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10055-I. Prepared by: Tufts Evidence-based Practice Center, Boston, MA
Suggested citation:
Dahabreh IJ, Chung M, Kitsios GD, Terasawa T, Raman G, Tatsioni A, Tobar A, Lau J, Trikalinos TA, Schmid CH. Comprehensive Overview of Methods and Reporting of Meta-Analyses of Test Accuracy. Methods Research Report. (Prepared by the Tufts Evidence-based Practice Center under Contract No. 290-2007-10055-I.) AHRQ Publication No. 12-EHC044-EF. Rockville, MD: Agency for Healthcare Research and Quality; March 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Tufts Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10055-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
The investigators have no relevant financial interests in the report. The investigators have no employment, consultancies, honoraria, or stock ownership or options, or royalties from any organization or entity with a financial interest or financial conflict with the subject matter discussed in the report.
- 1
540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
- NLM CatalogRelated NLM Catalog Entries
- Survey of the methods and reporting practices in published meta-analyses of test performance: 1987 to 2009.[Res Synth Methods. 2013]Survey of the methods and reporting practices in published meta-analyses of test performance: 1987 to 2009.Dahabreh IJ, Chung M, Kitsios GD, Terasawa T, Raman G, Tatsioni A, Tobar A, Lau J, Trikalinos TA, Schmid CH. Res Synth Methods. 2013 Sep; 4(3):242-55. Epub 2013 Jul 26.
- Review Screening for Chronic Obstructive Pulmonary Disease: A Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2016]Review Screening for Chronic Obstructive Pulmonary Disease: A Systematic Evidence Review for the U.S. Preventive Services Task ForceGuirguis-Blake JM, Senger CA, Webber EM, Mularski R, Whitlock EP. 2016 Apr
- Review A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy.[Health Technol Assess. 2005]Review A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy.Dinnes J, Deeks J, Kirby J, Roderick P. Health Technol Assess. 2005 Mar; 9(12):1-113, iii.
- Review Screening for Colorectal Cancer: A Systematic Review for the U.S. Preventive Services Task Force[ 2016]Review Screening for Colorectal Cancer: A Systematic Review for the U.S. Preventive Services Task ForceLin JS, Piper MA, Perdue LA, Rutter C, Webber EM, O’Connor E, Smith N, Whitlock EP. 2016 Jun
- Review Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force[ 2013]Review Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task ForceLin JS, O'Connor E, Rossom RC, Perdue LA, Burda BU, Thompson M, Eckstrom E. 2013 Nov
- Comprehensive Overview of Methods and Reporting of Meta-Analyses of Test Accurac...Comprehensive Overview of Methods and Reporting of Meta-Analyses of Test Accuracy
- PubChem Compound Links for Gene (Select 170673) (27)PubChem Compound
- "Autosomal dominant familial acute myeloid leukemia"[Disease/phen... (1)"Autosomal dominant familial acute myeloid leukemia"[Disease/phenotype] AND "GenomeConnect, ClinGen"[submitter]SearchClinVar
- enoyl-CoA delta isomerase 2 isoform 1 [Homo sapiens]enoyl-CoA delta isomerase 2 isoform 1 [Homo sapiens]gi|45643119|ref|NP_006108.2|Protein
Your browsing activity is empty.
Activity recording is turned off.
See more...