Systematic Reviews of Diagnostic Test Accuracy - New Developments within The Cochrane Collaboration

Abstract

During the last two decades, the number of systematic reviews and meta-analyses of diagnostic test accuracy has grown considerably and substantial progress has been made in developing and agreeing on methodological standards. The Cochrane Collaboration now considers it timely to register systematic reviews of diagnostic test accuracy studies, with the first Cochrane Diagnostic Test Accuracy Reviews scheduled to be published in the Cochrane Library in October 2008. Adding such reviews to the Cochrane Library may increase its appeal as the best single source of reliable evidence about the effects of health care. Systematic review of diagnostic test accuracy studies can be methodologically challenging. Diagnostic accuracy studies can be difficult to identify. They are likely to show substantial variability, because of small sample sizes, clinical diversity, due to differences in setting or spectrum, and because of differences in design. Unlike randomized trials, which report a single measure such as the relative risk, diagnostic test accuracy studies usually report a pair of measures of test performance, such as the test’s sensitivity and specificity, either at a point or along a ROC curve. Methods for meta-analysis have to take this bivariate nature of the data into account. In this paper we present some of the most recent developments in the methodology for conducting systematic reviews and meta-analyses of diagnostic test accuracy studies that will be incorporated in the Cochrane review process. Proefschrift Mariska.indd 14 12-05-2008 18:18:03 15 Systematic reviews of diagnostic test accuracy

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