Abstract
Diagnostic test accuracy (DTA) systematic reviews are conducted to summarize evidence on the accuracy of a diagnostic test including a critical evaluation of the primary studies. Where appropriate, the evidence is meta-analyzed to obtain pooled estimates of effectiveness.In this study, we reviewed and critiqued three DTA guidance documents with respect to the graphical presentation of DTA meta-analysis results. All three documents recommended the use of two forms of graphical presentation: (a) forest plots displaying meta-analysis results for sensitivity (ie, the true positive rate) and specificity (ie, true negative rate) separately, and (b) Summary Receiver Operating Characteristic (SROC) curve to provide a global summary of test performance. Two primary shortcomings were identified: (a) lack of incorporation of quality assessment results into the main analysis and; (b) ambiguity with which the contribution of individual studies is represented on SROC curves. In response, two alternative graphical approaches were developed:
1. A quality assessment enhanced SROC plot which displays the results from individual studies in the meta-analysis with multiple indicators of quality assessed using QUADAS-2; and
2. A percentage study weights enhanced SROC plot which accurately portrays the percentage contribution each study makes to the meta-analysis.
The proposed enhanced SROC curves facilitate the exploration of DTA data, leading to a deeper understanding of the primary studies included in a DTA meta-analysis including identifying reasons for between study heterogeneity and why specific study results may be divergent. Both plots can easily be produced in the free online interactive application, MetaDTA (https://crsu.shinyapps.io/dta_ma/).
Original language | English |
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Pages (from-to) | 34-44 |
Number of pages | 11 |
Journal | Research Synthesis Methods |
Volume | 12 |
Issue number | 1 |
Early online date | 24 Jul 2020 |
DOIs | |
Publication status | Published - Jan 2021 |
Bibliographical note
Funding Information:Amit Patel is funded by a National Institute for Health Research Systematic Review Fellowship (NIHR-RM-SR-2017-08-023) and Suzanne Freeman is funded by a National Institute for Health Research Post-Doctoral Fellowship (PDF-2018-11-ST2-007). Suzanne Freeman, Nicola Cooper and Alex Sutton are funded by the National Institute for Health Research Complex Reviews Support Unit (14/178/29). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health. The NIHR had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
Publisher Copyright:
© 2020 The Authors. Research Synthesis Methods published by John Wiley & Sons Ltd.
Keywords
- diagnostic test accuracy
- meta-analysis
- received operating characteristic curves
ASJC Scopus subject areas
- Education