Athina Tatsioni, MD; Deborah A. Zarin, MD; Naomi Aronson, PhD; David J. Samson, BA; Carole R. Flamm, MD, MPH; Christopher Schmid, PhD; Joseph Lau, MD
Diagnostic tests are critical components of effective health care. They help determine treatments that are most beneficial for a given patient. Their assessment is a complex process that includes such challenges as a dearth of studies that evaluate clinical outcomes and lack of data on use of the test in realistic clinical settings. The methodologic quality of studies of diagnostic tests also lags behind the qual ity of studies of therapeutic interventions. Statistical methods to combine diagnostic accuracy data are more complex and not as well developed, leading to difficulties in the interpretation of results. The Agency for Healthcare Research and Quality Technology Assessment Program has adopted a 6-level framework for evaluating diagnostic technologies. The model emphasizes the need for systematic reviews of diagnostic test studies to go beyond the assessment of technical feasibility and accuracy to examine the impact of the test on health outcomes. In this paper, we use examples from 3 Evidence-based Practice Center reports to illustrate 3 challenges reviewers may face when reviewing diagnostic test literature: finding relevant studies, assessing methodologic quality of diagnostic accuracy studies, and synthesizing studies that evaluate tests in different patient populations or use different outcomes.
The sensitivity and specificity estimate of each study is plotted, along with the overall results obtained by combining the estimates independently using a random-effects model.
The position of the ellipse corresponds to the sensitivity and specificity reported in the individual study. The size of the ellipse is weighted according to the study size. The summary receiver-operating characteristic curve is limited to the range where data are available.
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Tatsioni A, Zarin DA, Aronson N, Samson DJ, Flamm CR, Schmid C, et al. Challenges in Systematic Reviews of Diagnostic Technologies. Ann Intern Med. 2005;142:1048–1055. doi: 10.7326/0003-4819-142-12_Part_2-200506211-00004
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Published: Ann Intern Med. 2005;142(12_Part_2):1048-1055.
Cardiology, Coronary Heart Disease, Emergency Medicine, Healthcare Delivery and Policy.
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