Risk of bias assessment of test comparisons was uncommon in comparative accuracy systematic reviews: an overview of reviews

Research output: Contribution to journalReview articlepeer-review


  • Bada Yang
  • Yasaman Vali
  • Anahita Dehmoobad Sharifabadi Sharifabadi
  • Penny Whiting
  • Miranda Langendam
  • Mariska M G Leeflang

Colleges, School and Institutes

External organisations

  • Bristol Medical School, University of Bristol, Bristol, United Kingdom
  • Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.m.leeflang@amc.uva.nl.


Objectives: Comparative diagnostic test accuracy systematic reviews (DTA reviews) assess the accuracy of two or more tests and compare their diagnostic performance. We investigated how comparative DTA reviews assessed the risk of bias (RoB) in primary studies that compared multiple index tests. Study Design and Setting: This is an overview of comparative DTA reviews indexed in MEDLINE from January 1st to December 31st, 2017. Two assessors independently identified DTA reviews including at least two index tests and containing at least one statement in which the accuracy of the index tests was compared. Two assessors independently extracted data on the methods used to assess RoB in studies that directly compared the accuracy of multiple index tests. Results: We included 238 comparative DTA reviews. Only two reviews (0.8%, 95% confidence interval 0.1 to 3.0%) conducted RoB assessment of test comparisons undertaken in primary studies; neither used an RoB tool specifically designed to assess bias in test comparisons. Conclusion: Assessment of RoB in test comparisons undertaken in primary studies was uncommon in comparative DTA reviews, possibly due to lack of existing guidance on and awareness of potential sources of bias. Based on our findings, guidance on how to assess and incorporate RoB in comparative DTA reviews is needed.

Bibliographic note

Final Version of Record not yet available as of 30/09/2020


Original languageEnglish
Number of pages8
JournalJournal of Clinical Epidemiology
Early online date12 Aug 2020
Publication statusE-pub ahead of print - 12 Aug 2020


  • Bias, Diagnostic accuracy, Meta-analysis, Systematic review, Test comparison

ASJC Scopus subject areas