Incorporating quality assessments of primary studies in the conclusions of diagnostic accuracy reviews : a cross-sectional study
Date
2014-03-03
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
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.
Description
CITATION: Ochodo, E.A. et al. 2014. Incorporating quality assessments of primary studies in the conclusions of diagnostic accuracy reviews: A cross-sectional study. BMC Medical Research Methodology, 14:33, doi:10.1186/1471-2288-14-33.
The original publication is available at http://bmcmedresmethodol.biomedcentral.com
The original publication is available at http://bmcmedresmethodol.biomedcentral.com
Keywords
Diagnostic tests -- Evaluation, Test accuracy -- Evaluation, Diagnosis -- Evaluation, QUADAS
Citation
Ochodo, E.A. et al. 2014. Incorporating quality assessments of primary studies in the conclusions of diagnostic accuracy reviews: A cross-sectional study. BMC Medical Research Methodology, 14:33, doi:10.1186/1471-2288-14-33.