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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 and Author 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
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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.

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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.

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