The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Guidelines for Meta-analyses Evaluating Diagnostic Tests

Les Irwig, MBBCh, PhD; Anna N. A. Tosteson, ScD; Constantine Gatsonis, PhD; Joseph Lau, MD; Graham Colditz, MD, DrPH; Thomas C. Chalmers, MD; and Frederick Mosteller, PhD
[+] Article, Author, and Disclosure Information

From the University of Sydney, Sydney, Australia; Dartmouth Medical School, Hanover, New Hampshire; Harvard School of Public Health, Harvard Medical School, and the New England Medical Center, Boston, Massachusetts. Requests for Reprints: Les Irwig, MBBCH, PhD, Department of Public Health, Building A27, University of Sydney, New South Wales, Australia 2006. Acknowledgments: The authors thank Colin Begg, Gordon Guyatt, and David Sackett for review of the manuscript; Catherine Chock for assistance with data analysis; and Bruce Kupelnick and Clarence Zachery for assistance with literature searching and retrieval. Grant Support: In part by grant HS05936 from the Agency for Health Care Policy and Research.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(8):667-676. doi:10.7326/0003-4819-120-8-199404150-00008
Text Size: A A A

Objectives: To introduce guidelines for the conduct, reporting, and critical appraisal of meta-analyses evaluating diagnostic tests and to apply these guidelines to recently published meta-analyses of diagnostic tests.

Data Sources: Based on current concepts of how to assess diagnostic tests and conduct meta-analyses. They are applied to all meta-analyses evaluating diagnostic tests published in English-language journals from January 1990 through December 1991, identified through MEDLINE searching and by experts in the field.

Study Selection: Meta-analyses were included if at least two of three independent readers regarded their main purpose as the evaluation of diagnostic tests against a concurrent reference standard.

Data Extraction: By three independent readers on the extent to which meta-analyses fulfilled each guideline, with consensus defined as agreement by at least two readers.

Data Synthesis: The guidelines are concerned with determining the objective of the meta-analysis, identifying the relevant literature and extracting the data, estimating diagnostic accuracy, and identifying the extent to which variability is explained by study design characteristics and characteristics of the patients and diagnostic test. In general, the guidelines were only partially fulfilled.

Conclusion: Meta-analysis is potentially important in the assessment of diagnostic tests. Those reading meta-analyses evaluating diagnostic tests should critically appraise them; those doing meta-analyses should apply recently developed methods. The conduct and reporting of primary studies on which meta-analyses are based require improvement.


Grahic Jump Location
Figure 1.
Plot of true-positive rate on false-positive rate for thallium scintigrams to detect angiographic coronary artery disease.

Studies using computerized or semi-computerized reading techniques are shown as open circles and those using visual techniques as solid squares.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.