Yemisi Takwoingi, DVM; Mariska M.G. Leeflang, PhD; Jonathan J. Deeks, PhD
Acknowledgment: The authors thank Professor Chris Hyde, MBBS (University of Exeter), for providing clinical input; Mary Pennant, PhD (University of Birmingham), for assistance with data extraction; Sue Bayliss, BA (University of Birmingham), for assistance with searching; Georgina MacKenzie, MSc (Centre for Reviews and Dissemination, University of York), for providing the list of diagnostic reviews in DARE; and Richard Riley, PhD (University of Birmingham), for comments and suggestions on improving an earlier draft.
Grant Support: Dr. Takwoingi is funded through a United Kingdom National Institute for Health Research Award (DRF-2011-04-135). Dr. Leeflang is supported by the Netherlands Organization for Scientific Research (project 916.10.034). Dr. Deeks is partially supported by the Medical Research Council Midland Hub for Trials Methodology Research (grant number G0800808).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2051.
Requests for Single Reprints: Yemisi Takwoingi, DVM, Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham B15 2TT, United Kingdom; e-mail, email@example.com.
Current Author Addresses: Dr. Takwoingi and Dr. Deeks: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom.
Dr. Leeflang: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, PO Box 22700, Amsterdam 1100, the Netherlands.
Author Contributions: Conception and design: Y. Takwoingi, M.M.G. Leeflang, J.J. Deeks.
Analysis and interpretation of the data: Y. Takwoingi, J.J. Deeks.
Drafting of the article: Y. Takwoingi, M.M.G. Leeflang, J.J. Deeks.
Critical revision of the article for important intellectual content: Y. Takwoingi, M.M.G. Leeflang, J.J. Deeks.
Final approval of the article: Y. Takwoingi, M.M.G. Leeflang, J.J. Deeks.
Provision of study materials or patients: Y. Takwoingi.
Statistical expertise: Y. Takwoingi, J.J. Deeks.
Obtaining of funding: Y. Takwoingi, M.M.G. Leeflang.
Administrative, technical, or logistic support: Y. Takwoingi.
Collection and assembly of data: Y. Takwoingi, M.M.G. Leeflang.
Takwoingi Y, Leeflang MM, Deeks JJ. Empirical Evidence of the Importance of Comparative Studies of Diagnostic Test Accuracy. Ann Intern Med. 2013;158:544-554. doi: 10.7326/0003-4819-158-7-201304020-00006
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Published: Ann Intern Med. 2013;158(7):544-554.
Systematic reviews that “compare” the accuracy of 2 or more tests often include different sets of studies for each test.
To investigate the availability of direct comparative studies of test accuracy and to assess whether summary estimates of accuracy differ between meta-analyses of noncomparative and comparative studies.
Systematic reviews in any language from the Database of Abstracts of Reviews of Effects and the Cochrane Database of Systematic Reviews from 1994 to October 2012.
1 of 2 assessors selected reviews that evaluated at least 2 tests and identified meta-analyses that included both noncomparative studies and comparative studies.
1 of 3 assessors extracted data about review and study characteristics and test performance.
248 reviews compared test accuracy; of the 6915 studies, 2113 (31%) were comparative. Thirty-six reviews (with 52 meta-analyses) had adequate studies to compare results of noncomparative and comparative studies by using a hierarchical summary receiver-operating characteristic meta-regression model for each test comparison. In 10 meta-analyses, noncomparative studies ranked tests in the opposite order of comparative studies. A total of 25 meta-analyses showed more than a 2-fold discrepancy in the relative diagnostic odds ratio between noncomparative and comparative studies. Differences in accuracy estimates between noncomparative and comparative studies were greater than expected by chance (P < 0.001).
A paucity of comparative studies limited exploration of direction in bias.
Evidence derived from noncomparative studies often differs from that derived from comparative studies. Robustly designed studies in which all patients receive all tests or are randomly assigned to receive one or other of the tests should be more routinely undertaken and are preferred for evidence to guide test selection.
National Institute for Health Research (United Kingdom).
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