Abstract
BackgroundTo describe approaches used in systematic reviews of diagnostic test accuracy studies for assessing variability in estimates of accuracy between studies and to provide guidance in this area.MethodsMeta-analyses of diagnostic test accuracy studies published between May and September 2012 were systematically identified. Information on how the variability in results was investigated was extracted.ResultsOf the 53 meta-analyses included in the review, most (n=48; 91 %) presented variability in diagnostic accuracy estimates visually either through forest plots or ROC plots and the majority (n=40; 75 %) presented a test or statistical measure for the variability. Twenty-eight reviews (53 %) tested for variability beyond chance using Cochran’s Q test and 31 (58 %) reviews quantified it with I2. 7 reviews (13 %) presented between-study variance estimates (τ2) from random effects models and 3 of these presented a prediction interval or ellipse to facilitate interpretation. Half of all the meta-analyses specified what was considered a significant amount of variability (n=24; 49 %).ConclusionsApproaches to assessing variability in estimates of accuracy varied widely between diagnostic test accuracy reviews and there is room for improvement. We provide initial guidance, complemented by an overview of the currently available approaches.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-016-0108-4) contains supplementary material, which is available to authorized users.
Highlights
To describe approaches used in systematic reviews of diagnostic test accuracy studies for assessing variability in estimates of accuracy between studies and to provide guidance in this area
As this article is about formal methods for assessing variability in study results, we focused on the systematic reviews containing a meta-analysis
To facilitate interpretation of our results, we have provided an explanation of the terminology, different measures and statistical tests that are used when investigating variability in univariate analyses, like Cochran’s Q test, I2,τ2, and prediction intervals in Additional file 2
Summary
To describe approaches used in systematic reviews of diagnostic test accuracy studies for assessing variability in estimates of accuracy between studies and to provide guidance in this area. Analyzing the variability in results from primary studies is challenging in any type of systematic review, but it is even more difficult in systematic reviews of diagnostic studies. This is because the interest is often in two correlated estimates from the same study: pairs of sensitivity and specificity. Estimates of test accuracy are likely to differ between studies in a meta-analysis. This is referred to as Naaktgeboren et al BMC Medical Research Methodology (2016) 16:6 conclusions about the clinical implications of the findings of the meta-analysis [7]
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