Abstract
BackgroundPoor methodological quality and reporting are known concerns with diagnostic accuracy studies. In 2003, the QUADAS tool and the STARD standards were published for evaluating the quality and improving the reporting of diagnostic studies, respectively. However, it is unclear whether these tools have been applied to diagnostic studies of infectious diseases. We performed a systematic review on the methodological and reporting quality of diagnostic studies in TB, malaria and HIV.MethodsWe identified diagnostic accuracy studies of commercial tests for TB, malaria and HIV through a systematic search of the literature using PubMed and EMBASE (2004–2006). Original studies that reported sensitivity and specificity data were included. Two reviewers independently extracted data on study characteristics and diagnostic accuracy, and used QUADAS and STARD to evaluate the quality of methods and reporting, respectively.FindingsNinety (38%) of 238 articles met inclusion criteria. All studies had design deficiencies. Study quality indicators that were met in less than 25% of the studies included adequate description of withdrawals (6%) and reference test execution (10%), absence of index test review bias (19%) and reference test review bias (24%), and report of uninterpretable results (22%). In terms of quality of reporting, 9 STARD indicators were reported in less than 25% of the studies: methods for calculation and estimates of reproducibility (0%), adverse effects of the diagnostic tests (1%), estimates of diagnostic accuracy between subgroups (10%), distribution of severity of disease/other diagnoses (11%), number of eligible patients who did not participate in the study (14%), blinding of the test readers (16%), and description of the team executing the test and management of indeterminate/outlier results (both 17%). The use of STARD was not explicitly mentioned in any study. Only 22% of 46 journals that published the studies included in this review required authors to use STARD.ConclusionRecently published diagnostic accuracy studies on commercial tests for TB, malaria and HIV have moderate to low quality and are poorly reported. The more frequent use of tools such as QUADAS and STARD may be necessary to improve the methodological and reporting quality of future diagnostic accuracy studies in infectious diseases.
Highlights
Tuberculosis (TB), malaria and human immunodeficiency virus (HIV), the ‘big three’ among infectious diseases, are major global causes of morbidity and mortality
Recently published diagnostic accuracy studies on commercial tests for TB, malaria and HIV have moderate to low quality and are poorly reported
The 90 studies included were published in 46 different medical journals, Fifty percent evaluated TB diagnostic tests, 21% malaria diagnostic tests, and 29% HIV diagnostic tests
Summary
Tuberculosis (TB), malaria and human immunodeficiency virus (HIV), the ‘big three’ among infectious diseases, are major global causes of morbidity and mortality. Together, they cause more than 3.5 million deaths per year.[1,2,3] considerable financial and other investments have been directed towards the control of these diseases in recent years, which includes the development of diagnostic and treatment services that are accessible to patients. Simple and robust technological platforms that allow rapid diagnostic testing at the primary health care level have greatly increased diagnostic capability, in developing countries. We performed a systematic review on the methodological and reporting quality of diagnostic studies in TB, malaria and HIV
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